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Columtiia  ZHnibersJitjf 
inttieCitpcifJtetagcirfe 

CoUese  of  $jjj>gicians;  anb  ^urgeonsi 


3^ef  erence  Mrarp 


THE  ASSOCIATION 


HUMAN    AND    BOVINE 
TUBERCULOSIS, 


By    E.   F.   Brush,    M.    D., 


MOUNT  VERNON,  NEW  YORK, 


Wynkoop  Hallenbbck  Crawford  Co. 

PRINTERS, 

NEW   YORK  AND  ALBANY, 


PREFACE. 

The  following  pages  are  devoted  to  the  repub- 
lication of  some  old  papers  presented  to  the 
medical  profession  during  the  past  ten  years. 
The  reprint  from  the  medical  journals,  from  5,000 
to  7,000  of  each,  have  been  exhausted  (as  they 
were  given  away).  Requests  for  some  of  the 
articles  are  still  coming  in;  hence,  the  reproduc- 
tion in  book  form.  There  is  no  claim  that  these 
magazine  essays  are  of  sufficient  importance  to 
be  preserved  in  a  bound  volume;  but  as  the 
subject-matter  is  one  that  is  now  attracting,  as  it 
deserves,  an  increased  public  attention,  it  may 
be  that  some  of  the  arguments  and  alleged  facts 
here  presented  may  be  deemed  worthy  of  con- 
troversy, and  thus  lead  to  the  truth,  which  has 
been  one  of  the  desires  of  the  author. 

Mount  Vernon,  N.  Y.,  April,  1898. 


BOVINE  TUBERCULOSIS.* 

After  passing  through  the  various  controver- 
sies regarding  gray  tubercle,  yellow  tubercle, 
giant  cells,  scrofulosis,  etc.,  at  the  present  time 
we  find  the  question  of  tuberculosis  narrowed 
down  to  bacillary  infection,  and  we  are  con- 
fronted with  the  inquiry,  ''  Is  bacillary  tubercu- 
losis conveyed  to  the  human  race  from  animals 
affected  with  this  disease?  " 

All  civilized  races  on  the  face  of  the  globe  have 
surrounded  themselves  with  domestic  animals. 
We  have  the  horse,  the  pig,  the  sheep,  the  goat, 
the  dog,  the  cow,  and  others.  Of  these  we  find 
that  the  horse  is  entirely  exem.pt  from  tubercu- 
losis. The  sheep,  the  goat  and  the  dog  are  not 
found  in  nature  affected  with  this  disease,  and 
they  likewise  resist  artificial  infection  well;  under 
certain  condition  the  pig  takes  on  tuberculosis; 
it  is,  in  fact,  from  this  animal  that  we  get  our 
word  scrofulosis.  But,  as  we  find  them  at  the 
present  timie,  they  are  not  tubercular,  because  in 
this  animal  in-and-in  breeding,  which  favors  the 

♦Read  before  the  Medical  Society  of  the  State  of  New  York,  February  7, 
1888.    Reprinted  from  the  New  York  "  Medical  Journal." 


6  Bovine  Tuberculosis. 

development  of  tuberculosis  in  all  creatures 
prone  to  this  affection,  is  not  profitable  to  the 
breeder,  as  swine  animals  of  close  consanguinity 
fail  to  have  young  as  a  rule,  and,  if  they  do,  the 
offspring  dies  soon  after  birth.  Thus  breeders 
are  careful  to  put  sows  to  boars  not  at  all  related, 
and  we  find  the  pig  of  the  present  day  remarka- 
bly exempt  from  scrofulosis.  The  only  reliable 
statistics  to  which  I  have  access  are  some  com^- 
piled  in  Bavaria  in  1879,  According  to  these, 
of  66,403  animals  slaughtered  for  food,  only  two 
swine  v/ere  found  to  be  tubercular.  When,  how- 
ever, we  come  to  the  bovine  race,  we  find  among 
these  domesticated  anim.als  alv/ays  a  certain  per- 
centage of  them  affected  v/ith  tuberculosis  in  its 
various  forms.  In  fact,  this  race  and  the  human 
are  pre-eminently  tubercular.  In  all  the  experi- 
ments of  the  present  day,  whether  inoculation  or 
cultivation,  matter  from  either  the  human  or  the 
bovine  race  is  used;  and  the  question  pro  and  con 
relating  to  the  contagiousness  of  this  disease  lies 
between  these  two  races.  Of  all  the  domesticated 
animals  known,  none  is  so  intimately  or  closely 
related  to  the  human  race  as  the  cow.  We  are 
veritable  parasites  on  this  animal.  We  milk  her 
as  long  as  she  will  give  milk,  and  we  drink  it; 
then  we  kill  her,  eat  her  flesh,  blood,  and  most 
of  the  viscera;  we  skin  her,  and  clothe  ourselves 


Bovine  Tuberculosis.  7 

with  her  skin;  we  com1)  our  hair  with  her  horns, 
and  fertilize  our  fields  with  her  dung,  while  her 
calf  furnishes  us  with  vaccine  virus  for  the  pre- 
vention of  small-pox.  Strange  it  would  be,  in- 
deed, if,  under  all  these  circumstances,  we  did 
not  acquire  from  her  some  malady;  she  has  tu- 
berculosis, and  we  have  tuberculosis;  certain  it  is 
she  does  not  acquire  it  from  us.  Artificial  inocu- 
lation of  tubercular  matter  from  the  cow  in  very 
many  cases  tubercularizes  other  animals,  and,  by 
the  success  of  many  of  these  experiments,  scien- 
tific men  have,  many  of  them,  been  excited  into 
becoming  alarmists,  and  have  appeared  before 
the  world  in  print  with  sweeping  and  starthng 
assertions,  but  have  failed  to  attract  the  attention 
they  deemed  their  alarms  entitled  to. 

The  question  of  the  contagiousness  of  the 
disease  under  consideration  is  an  old  one.  Mor- 
ton, writing  200  years  ago  on  consumption, says: 
"  This  disease  is  also  propagated  by  infection, 
for  this  distemper,  as  I  have  observed  it  by  fre- 
quent experience,  like  a  contagious  fever,  doth 
infect  those  that  lie  with  a  sick  person  with  a 
certain  taint."  Although  this  statement  has  been 
reiterated,  and  many  of  us  have  become  con- 
vinced from  our  own  experience,  fewbelieve  that 
it  is  contagious  among  the  human  race.  At  a 
recent  meeting  in  England,  when  the  question 


8  Bovine  Tuberculosis. 

was  under  discussion,  Dr.  Henry  Bennett  ex- 
claimed: ''  Such  a  theory  is  dangerous,  because, 
if  it  were  true,  the  disease  would  be  worse  than 
the  plague,  and  each  tubercular  patient  would 
have  to  be  treated  as  were  the  lepers  of  old." 
This  is  a  queer  statement,  and  evinces  in  a  cer- 
tain degree  human  perversity.  I  do  not  know 
vvhat  there  is  about  this  disease  which  fails  to 
alarm  the  human  race ;  it  is  contagious,  insidious, 
deceitful  and  destructive.  Men  afflicted  unto 
death  are  seldom  or  never  convinced  that  they 
are  dying.  As  illustrating  this  strange  human 
fallacy,  we  notice  that  at  one  time  in  Germany 
the  name  for  tuberculosis  in  cattle  was  Franzo- 
scnkrankheit,  the  then  popular  namic  for  syphilis, 
and  hence  for  a  long  time  the  flesh  of  animals 
thus  diseased  was  not  eaten  in  that  country;  but 
when  they  found  that  the  disease  was  simply 
tuberculosis — an  affection  that  kills  a  far  greater 
number  than  the  other  disease — they  fell  to  eat- 
ing the  meat  again,  just  as  we  do. 

Virchow  says:  ''  Man  is  far  m.ore  susceptible 
to  the  diseases  of  animals  than  the  latter  are  to 
similar  diseases  from  man."  Now,  if  Virchow  is 
right,  and  he  generally  is,  the  question  arises, 
Why  are  not  more  of  the  human  race  tubercular, 
as  we  find  a  certain  percentage  of  ah  cows  that 
furnish  milk  and  meat  to  the  human  race  are 


Bovine  Tuberculosis.  9 

tubercular?  Fleming  reckons  that  5  per  cent, 
of  all  the  bovines  in  England  are  infected.  Wc 
have  no  complete  statistics  on  this  matter. 

I  have  been  told  by  inspectors  of  the  Bureau 
of  Animal  Industry  that  a  much  larger  percent- 
age of  our  cows  are  affected.  Indeed,  among 
the  thoroughbred  Jerseys  in  the  northern  States 
20  per  cent,  are  affected,  as  I  have  been  told  by 
Professor  R.  A.  McLean,  the  chief  of  this  dis- 
trict from  the  bureau.  Now,  with  this  large  per- 
centage of  tubercular  cows,  and  assuming  that 
it  is  a  fact  that  tuberculosis  is  communicated 
from  the  bovine  to  the  human  race,  and  consid- 
ering our  close  relationship  to  the  animal,  why 
are  not  more  of  the  human  race  killed  by  this 
disease? 

The  total  number  of  cows  in  the  United  States 
for  the  year  1887  was  14,522,083  —  that  is,  one 
cow  to  every  four  and  three-tenths  (4.3)  persons. 
There  exists,  according  to  Lynt,  a  true  parallel 
betvv^een  bovine  and  human  phthisis;  the  curves 
of  double  mortalit}^  are  the  same  for  different 
districts  in  the  Duchy  of  Baden.  Now  this  must 
mean  that  a  larger  proportion  of  the  bovine  race 
dies  from  phthisis  than  of  the  human  race,  be- 
cause of  the  difference  in  the  length  of  life  be- 
tween the  races.  We  have  no  statistics  of  this 
kind  in  the  United  States,  but  Professor  R.  A. 


lo  Bovine  Tuberculosis. 

McLean,  the  authority  before  referred  to,  tells 
me  that  where  cows  are  affected  by  tuberculosis 
in  great  numbers,  the  death-rate  from  phthisis  is 
correspondingly  large  in  the  human  race  in  the 
same  districts.  This  is  his  observation  from  his 
large  experience  among  diseased  cattle. 

Now  let  us  see  what  the  conditions  of  the  two 
races  are,  howthey  differ, and  how  this  difference 
modifies  the  disease  under  consideration.  With- 
out going  into  detail  in  comparing  the  two,  you 
will  find,  after  due  comparison,  the  most  marked 
difference  to  be  that  of  the  normal  temperature 
of  the  tw^o  races,  and  this  difference  you  will  at 
once  concede  is  of  more  effect  in  relation  to  the 
disease  than  any  of  the  other  conditions.  Many 
years  ago  I  made  an  attempt  to  discover  the  true 
normal  temperature  of  the  cow  by  thermometric 
observations  of  large  herds  in  the  field,  and  be- 
came completely  puzzled  at  the  lack  of  uniform- 
ity and  the  very  high  average.  I  then  searched 
my  books  for  some  authority  on  the  subject,  and 
found  a  lamentable  ignoring  of  the  whole  ques- 
tion in  many  works  relating  to  bovine  pathology. 
The  only  allusion  I  could  find  was  in  Steele's 
work,  which,  while  excellent  in  some  other  re- 
spects, simply  quotes  bovine  temperature  from 
Armatage,  and  this  quotation  was  in  turn  a  quo- 
tation from  an  English  book  out  of  print,  the 


Bovine  Tuberculosis.  ii 

name  of  whose  author  was  not  given.  These 
quoted  temperatures  (100.9°  ^-  ^^  101.9°  F.)  are 
much  lower  than  the  resuUs  of  my  observations, 
and  the  differences  I  observed  in  the  range  were 
far  greater.  I  have  found  cows  in  apparently 
perfect  health  with  a  temperature  of  103.5°  ^y 
and  ranging  from  that  down  to  101.2°  F.  From 
my  own  observations  among  cows  and  the  expe- 
rience as  given  in  books,  I  find  that  all  the  ani- 
mals endowed  with  hairy  and  woolly  coats,  but 
without  well-developed  sudorific  glands  —  that 
is,  that  do  not  sweat  readily  —  do  not  maintain 
a  uniformity  of  temperature.  The  difference  be- 
tween a  quiescent  condition  and  one  of  activity 
is  several  degrees  without  affecting  the  health. 
But  all  these  animals  have  a  higher  range  ot 
temperature  than  the  human  species.  Thus  we 
find  in  the  published  tables  the  following  figures: 
Cows  and  oxen  during  confinement,  100.8°  F. ; 
during  work  and  liberty,  101.8°;  calves  and  stirks 
during  confinement,  100.9°;  during  work  and 
liberty,  101.8°;  sheepduring  confinement,  102.5°; 
at  liberty,  104.5°;  lambs  at  liberty,  104.9°;  pigs 
in  confinement,  101.6°;  at  liberty,  103.2°;  dogs  in 
confinement,  99.3°;  at  liberty,  101.9°;  and  horses 
in  confinement, 99.2°;  atworkand  hberty,  100.3°; 
rabbits,  103°;  guinea-pigs,  102°;  the  common 
fowl,  106.7°. 


12  Bovine  Tuberculosis. 

Now,  if  you  compare  this  table  with  all  the 
recent  inoculation  experiments  on  bovine  tuber- 
culosis, you  will  find  that  the  success  of  such  ex- 
periments is  in  direct  ratio  with  the  tempera- 
tures —  that  is,  commencing  with  the  lower  tem- 
perature, that  of  the  dog,  we  find  the  resistance 
lessening  as  we  go  up  the  scale  till  we  come  to 
the  common  fowl,  with  the  highest  temperature, 
where  there  is  no  resistance  whatever.  Feeding 
Vvdth  tubercular  matter  is  ahvays  positive  with 
this  bird. 

We  can  noAv  see  why  the  human  race  is  not 
more  extensively  affected  with  tuberculosis, 
which,  in  my  candid  opinion,  is  all  derived  from 
the  bovine  race.  A  germ  cultivated  in  the  cow 
is  a  tropical  growth,  because  her  average  tem- 
perature is  between  ioi°  and  103°  F.  The  hu- 
man race,  by  this  mode  of  illustration,  represents 
the  temperate  zone.  Coffee  v/ill  not  grov/  in 
Connecticut  unless  3^ou  put  it  in  a  hot-house. 
Ringer,  in  his  valuable  little  m.onograph  on -the 
tem.perature  of  the  body  as  a  means  of  diagnosis 
and  prognosis  in  phthisis,  states  that  in  acute 
cases  the  temperature  of  the  human  body  rises 
daily  to  a  high  point —  103°  to  105°.  Further, 
a  patient  in  previous  good  health  is  seized  with 
pretty  copious  and  repeated  haemoptysis;  there 
are  no  physical  signs,  and  beyond  a  cough  and 


Bovine  Tuberculosis.  13 

an  elevated  temperature  of  102°  or  103°  F.  there 
is  no  evidence  of  phthisis.  These  symptoms  are, 
however,  sufficient  to  declare  the  nature  of  the 
case.  Thus  you  will  see  that  the  temperature,  as 
cited  here  by  Ringer,  is  about  the  normal  tem- 
perature of  the  bovine  race.  Ringer  further 
says:  "  Thus,  in  all  cases  observed  in  which  the 
deposition  of  tubercle  was  going  on  there  was  a 
continual  elevation  of  the  temperature,  while  in 
those  cases  in  which  the  deposition  had  ceased 
the  temperature  was  normal."  To  quote  further 
from  Ringer,  whose  testimony  is  valuable  on  this 
point:  "  Thus  we  meet  with  cases  of  phthisis  ac- 
companied with  elevation  of  temperature  during 
several  weeks  before  we  get  physical  signs  indi- 
cative of  the  deposition  of  tubercle."  Now,  al- 
though Ringer  does  not  draw  such  a  conclusion 
from  this  fact,  the  interpretation  is  plain  to  me 
that  from  some  cause  or  other  the  temperature 
was  increased  to  the  right  degree  to  start  the 
growth  of  the  bacillus  tuberculosis,  which,  when 
well  started,  like  all  other  ferments,  had  the 
power  of  keeping  up  the  temperature  by  its  own 
activity.  That  is,  the  temperature  has  been  in- 
creased to  the  proper  degree  to  permit  of  the 
growth  of  the  bacillus,  and  the  deposition  of 
tubercle  is  simply  the  result  of  the  multiplicity  of 
bacilli  creating  for  themselves  places  of  congre- 


14  Bovine  Tuberculosis. 

gatioii.  At  least,  I  take  it  that  this  is  the  true 
relation  of  the  germ  to  the  tubercle.  The  germ 
does  not  kill  directly,  but  an  aggregation  of  the 
bacilli  surrounded  by  the  new  growth  is  the  tu- 
bercle, and  when  the  tubercle  is  formed  the  germ 
has  finished  its  activity;  and,  if  this  new  forma- 
tion becomes  organized  or  certified,  death  does 
not  result,  but  if  the  tubercle,  that  has  been 
formed  simply  as  a  resting-place  for  the  bacillus, 
breaks  down,  death  results  from  sepsis. 

These  facts  relating  to  temperature  also  illus- 
trate localized  deposits  of  tubercle  from  trauma- 
tism. Thus,  a  human  body  in  which  the  bacilli 
are  already  present,  but  not  growing  for  lack  of 
temperature,  finds  it  proper  conditions  where  the 
temperature  is  raised  by  reason  of  the  injury,  as 
traumatisms  always  produce  local  inflammatory 
action.  If  this  theory  is  accepted,  the  argument 
regarding  the  scrofulous  origin  of  joint  diseases 
becomes  superfluous;  both  parties,  in  fact,  have 
been  right.  In  further  proof  that  a  high  tempera- 
ture is  necessary  for  the  growth  of  the  bacillus 
tuberculosis,  the  late  Dr.  Flint,  in  his  valuable 
Vv^ork  on  practice,  says:  "  I  do  not  hesitate  to 
express  the  belief  that  in  a  certain  proportion  of 
cases  alcohol  exerts  a  curative  influence  in  pul- 
monary phthisis."  WunderHch,  in  his  valuable 
book  on  ''  Medical  Thermometry,"  writes:   ''  In 


Bovine  Tuberculosis.  15 

febrile  conditions  the  effect  of  alcohol  is  to  lower 
the  temperature."  He  also  says:  "  Habitual 
drinkers  have,  as  a  rule,  under  parallel  circum- 
stances, a  lower  temperature  than  other  persons." 

Not  only  does  temperature  play  an  active  part 
in  the  creation  of  tuberculosis  as  a  disease,  but 
we  find  that  in  cultivations  outside  of  the  body 
it  requires  a  nicer  adjustment  of  temperature 
than  any  of  the  other  germs. 

In  regard  to  the  role  played  by  the  temperature 
in  the  disease  under  consideration,  we  have  a 
very  interesting  experiment  of  Toussaint's.  He 
extracted  some  juice  from  the  lung  of  a  tuber- 
cular cow;  some  of  this  virus  he  injected  into  a 
pig  and  two  rabbits;  then  he  heated  in  a  water- 
bath  part  of  the  same  virus  to  a  130°  and  137°  F. 
for  ten  minutes,  and  injected  the  virus  into  four 
hogs  and  four  rabbits.  He  says  general  infec- 
tion occurred  very  rapidly  in  all  these  animals. 
Curious  to  state,  the  rabbits  that  had  been  inocu- 
lated with  the  heated  liquid  died  before  the 
others. 

The  only  cited  experiment  that  I  can  find 
where  tuberculosis  was  conveyed  directly  from 
the  bovine  to  the  human  race  I  clipped  from  the 
Nev^  York  "  Medical  Record  "  some  years  ago: 
''Two  Greek  physicians  inoculated  a  patient  who 
was  dying  of  gangrene  of  the  leg  with  tubercular 


i6  Bovine  Tuberculosis. 

matter  from  a  cow.  They  state  that  the  patient's 
lungs  were  healthy  prior  to  the  inoculation,  and 
at  the  autopsy  there  were  well-marked  tubercular 
deposits  in  the  lungs."  If  this  is  an  authenticated 
case,  which,  of  course,  I  cannot  affirm,  there  was 
undoubtedly  the  proper  temperature  for  the 
growth  of  the  germs,  and  hence  the  success  of 
the  experiment. 

My  occupation  brings  me  into  close  contact 
with  dairy  cattle,  and  I  have  therefore  been  com- 
pelled to  devote  my  attention  to  the  subject  of 
the  diseases  afflicting  dairy  stock.  That  there  is 
a  large  number  of  dairy  cows  afflicted  with  tuber- 
culosis I  can  affirm;  that  there  has  never  been  an 
attempt  to  exterminate  this  disease  is  a  fact  of 
which  I  am  also  cognizant.  Last  year  the  Fed- 
eral government  appropriated  half  a  milHon  dol- 
lars to  stamp  out  zymotic  pleuro-pneumonia. 
This  disease  does  not  affect  the  human  race,  as 
no  other  animal  except  the  bovine  has  ever  been 
known  to  suiTer  from  it.  It  affects  the  pockets 
of  the  cattle-dealers  grievously;  but  the  health  of 
the  general  public  is  not  threatened  by  it,  while 
bovine  tuberculosis,  which  the  government  in- 
spector finds  coincident  with  a  high  death-rate  in 
human  phthisis,  is  left  uncontrolled.  Cattle- 
breeders  everywhere  have  unrestrictedly  fol- 
lowed the  homicidal  practice  of  in-and-in  breed- 


Bovine  Tuberculosis.  17 

ing  of  dairy  stock.  This  method  of  i3reeding  we 
all  know  favors  the  development  of  the  disease, 
and  the  development  of  this  disease  in  the  bovine 
race  simply  means  more  phthisis  in  the  human 
race.  One  simple  fact  that  strengthens  my  be- 
lief that  human  bacillary  tuberculosis  is  all  de- 
rived from  the  bovine  species  is,  that  where  this 
animal  does  not  exist,  pulmonary  consumption 
is  unknown.  The  Kirghis  on  the  steppes  of 
Russia,  who  have  no  cows,  have  domesticated 
the  horse,  using  its  milk,  meat  and  skin,  and  a 
case  of  pulmonary  tuberculosis  has  never  been 
known  to  exist  among  the  tribe.  The  Esqui- 
maux has  no  cows,  neither  has  he  pulmonary 
phthisis,  and  I  think  it  can  be  laid  down  as  a  fact 
that  where  the  dairy  cow  is  unknown  pulmionary 
consumption  does  not  prevail. 

Among  the  numerous  statistics  giving  the  oc- 
cupation of  those  persons  who  die  of  bacillary 
phthisis,  I  do  not  find  the  occupation  of  a  farmer 
included;  my  own  observations  in  farming  dis- 
tricts convince  me  that  large  numbers  of  these 
people  die  of  lung  tuberculosis.  That  these 
people  are  in  greater  danger  of  infection  from 
milk  from  tubercular  cows  is  evident  from  the 
fact  that  they  very  often  drink  the  milk  "  warm 
from  the  cow,"  while  the  city  consumer  almost 
2 


i8  Bovine  Tuberculosis. 

ahvays  gets  his  milk  after  it  has  been  chilled,  and 
ail  the  cultivation  experiments  go  to  prove  that 
this  germ  will  not  grow  at  a  temperature  of  less 
than  87°  F.  The  reason  why  these  farmers' 
deaths  are  not  included  in  statistics  is  due  to 
their  remoteness  from  the  great  centers  where 
the  statistics  are  collected. 

The  cow  has  redeemed  us  from  one  dreadful 
scourge,  small-pox.  I  am,  however,  inclined  to 
think  a  greater  scourge  is  continued  to  us  by 
the  same  animal.  It  is  the  deceitfulness  and  in- 
sidiousness  of  this  disease  that  lure  us  into  a 
quiet  state.  Bacillary  infection  is  not  rapidly 
fatal  as  a  rule;  the  infection  received  into  the  sys- 
tem of  a  human  being  lies  in  wait  for  a  proper  con- 
dition of  its  host  before  it  can  assert  its  sway,  and, 
if  the  opportunity  never  occurs  in  the  individual 
originally  infected,  the  infection  is  continued  to 
the  offspring,  and  the  wasting  bacillus  finds  its 
opportunity  some  time.  Men  never  know  when 
they  receive  the  infection  that  results  in  a  fatal 
attack  of  pulmonary  phthisis. 

We  long  ago  acknowledged  our  inability  to 
check  this  scourge  when  it  has  once  got  its  in- 
sidious grip  on  a  human  creature.  Certain  cases 
do  end  in  recovery,  but  under  circumstances  that 
thus  far  we  have  been  unable  to  comprehend; 
we  have  no  known  methods  of  successful  treat- 


Bovine  Tuberculosis.  19 

ment.  Let  us  then,  as  medical  men,  turn  our 
attention  to  prophylactics. 

There  is  no  good  reason  why  we  cannot  be 
instrumental  in  passing  laws  to  regulate  the 
breeding  of  dairy-stock.  The  disease  is  well 
marked;  therefore,  there  would  be  little  difhculty 
in  selecting  animals  afflicted  and  excluding  them 
from  the  dairy  and  butchers'  shops,  and  in  indi- 
cating to  our  legislators  the  necessity  of  passing 
laws  to  prevent  the  breeding  together  of  tuber- 
cular animals,  or  the  in-and-in  breeding  of  any  of 
the  bovine  species.  Let  us  treat  this  disease,  es- 
pecially among  the  cows,  as  leprosy  was  treated 
of  old,  and  then  vvC  shall  be  saved  from  the  pain- 
ful necessity  of  treating  the  human  race  in  like 
manner,  for  I  am  convinced  that,  if  we  stamp  out 
tuberculosis  in  the  bovine  race,  a  few  genera- 
tions v/ill  eliminate  it  from  the  human  family. 

Since  the  presentation  of  my  paper,  I  have  re- 
ceived numerous  inquiries  respecting  the  diag- 
nosis of  tuberculosis  in  the  cow.  One  country 
practitioner  says  he  never  saw  a  milch  cow  with 
tuberculosis,  and  could  not  understand  how  the 
disease  could  be  so  prevalent  and  yet  not  be 
more  apparent. 

Tuberculosis  is  emphatically  a  bovine  disease; 
this  race  can  be  tubercular  from  birth  to  old  age, 
and  yet  no't  die  from  this  disease.   It  is  only  when 


20  Bovine  Tuberculosis. 

the  surroundings,  lack  of  care,  and  other  bad 
hveienic  conditions  lower  the  resistance  that 
caseation  of  the  tubercular  mass  takes  place,  and 
the  animal  dies  from  sepsis. 

The  diagnosis  of  tuberculosis  in  the  cow  is 
just  as  simple  as  in  the  human  famxily.  We 
recognize  in  this  latter  the  general  appearance  of 
an  individual  with  a  phthisical  habit,  or  scrofu- 
lous; and  in  the  same  manner,  after  becoming 
familiar  with  the  disease  in  the  cow,  one  recog- 
nizes a  suspicious  appearance,  which  requires  to 
be  verified  by  percussion  and  auscultation. 

The  prominent  sign  of  a  suspicion  of  tubercu- 
losis in  the  cow  is  an  enlargement  of  the  inguinal 
gland.  Coincidently  with  the  deposition  of  tu- 
bercular matter  in  other  locations  there  is  a 
marked  tendency  of  the  lymphatic  glands  to 
become  focuses  of  infection.  These  glands  are 
usually  infected  in  groups,  those  of  the  larynx, 
pharynx,  trachea,  lung  and  heart,  the  abdominal 
and  the  inguinal.  It  is  the  enlargement  of  this 
last-named  gland,  which  can  be  so  plainly  ob- 
served even  by  a  casual  examination,  that  indi- 
cates a  tubercular  condition.  I  never  have  seen 
a  tuberculous  cow  without  an  enlarged  inguinal 
'gland.  Of  course,  this  gland  may  become  en- 
larged from  other  causes;  but  just  as  we  feel  for 
an  enlargement  of  the  post-cervical  glands  in  a 


Bovine  Tuberculosis. 


21 


supposed  case  of  syphilis,  so  the  enlargement  of 
the  inguinal  glands  in  the  cow  must  be  looked 
for,  and  they  are  just  as  strong  a  diagnostic  indi- 
cation of  tuberculosis  in  the  bovine  race  as  the 
post-cervical  glandular  enlargement  is  of  syphilis 
in  the  human  race. 


The  first  illustration  is  one  that  I  have  had 
engraved  from  a  photograph,  and  shows  this  en- 
largement. You  will  notice  a  prominence  just 
in  front  of  the  letter  A,  on  the  animal's  thigh. 
The  history  of  this  case  may  be  interesting  as 
illustrating  the  diagnostic  value  of  this  glandu- 
lar appearance.  Last  winter,  a  doctor,  a  friend 
of  mine,  was  showing  me  a  number  of  photo- 
graphs of  famous  cattle,  among  which  was  the 
one  from  which  this  engraving  is  taken.     The 


22  Bovine  Tuberculosis. 

general  appearance  of  this  bull,  together  with 
the  prominent  appearance  of  the  inguinal  gland, 
at  once  attracted  my  attention,  and  I  said  ''  This 
is  a  tuberculous  animal."  The  possessor  of  the 
picture  smiled  at  my  suspicion;  nevertheless,  he 
lent  me  the  picture,  as  I  told  him  I  knew  the  pur- 
chaser of  this  bull,  and  therefore  could  learn 
from  him  all  about  the  animal.  A  few  days  later 
I  met  the  gentleman  who  had  had  charge  of  the 
herd  to  which  the  bull  belonged,  and  obtauied 
from  him  the  following  statement:  The  bull  v/as 
bought  in  France  for  a  very  large  sum  of  money, 
because  he  was  so  closely  inbred  as  to  have  a 
larger  percentage  of  the  famous  Cobm_assie  blood 
than  any  other  animial  living  at  that  time.  He 
vv^as  used  for  a  short  time  in  the  herd  for  which 
he  was  purchased,  and  then  was  sold  at  auction, 
bringing  a  price  numbered  in  the  thousands  of 
dollars.  He  was  sent  West,  where  his  purchaser 
lived,  and  he,  in  order  to  get  back  his  money, 
allowed  the  bull  to  serve  a  large  number  of  cows 
shortly  after  his  journey.  Then  the  bull  caught 
cold  and  died.  No  suspicion  of  tuberculosis  was 
ever  entertained,  although  the  narrator  of  the 
foregoing  history  replied,  in  reference  to  one 
of  my  remarks:  ''  It  always  seemed  to  me  a  very 
funny  circumstance  that  a  bull,  used  to  ordinary 
stabling,  and  its  accompanying  draughts,  should 


Bovine  Tuberculosis.  23 

catch  cold  in  July,  in  haying-time,  and  die  from 
such  a  cold." 

The  second  illustration  is  from  a  photograph 
of  the  chief  bull  of  my  herd,  a  Holstein,  bred  by 
William  M.  Singerly,  of  Philadelphia.  In  his 
breeding,  there  is  not  a  single  repetition  of  an 
animal  as  far  back  as  his  pedigree  goes  in  the 
"  Holstein  Herd  Book;  "  none  of  his  progenitors 
were  at  all  related.    You  will  observe  how  much 


larger,  stronger  and  rugged  his  appearance  is 
than  that  of  the  tuberculous  Jersey.  The  differ- 
ence in  the  formation  of  the  chest  and  shoulders 
is  well  marked,  and,  as  the  engraving  shows, 
there  are  no  indications  whatever  of  glandular 
enlargements.  I  introduce  these  engravings  to 
illustrate  two  distinct  types  —  first,  an  inbred 
tuberculous  animal,  and  secondly,  a  rationally 
bred,  healthy,  robust  animal. 


[Reprinted  from  The  New  York  Medical  Journal,  June  15,  1889.] 

THE     RELATIONSHIP     EXISTING    BE- 
TWEEN HUMAN  AND   BOVINE 
TUBERCULOSIS.* 

A  strangely  interesting  phase  of  the  study  of 
phthisis  is  that  presented  by  the  disease  in  hving 
beings.  In  the  human  race  the  afflicted  are  gen- 
erally the  most  attractive  members  of  society. 
Scrofulous  females  are  usually  among  the  most 
beautiful  people  we  meet,  with  their  transparent 
complexion  and  large  languid  eyes,  while  the 
scrofulous  males  are  either  intensely  intellectual 
or  correspondingly  erotic.  The  same  rule  holds 
good  in  the  bovine  race;  the  small  inbred  tuber- 
cular Jersey  is  in  appearance  the  most  attractive 
of  any  of  the  cow  tribe,  while  even  the  common 
scrub  cow  that  is  tubercular  has  a  certain  beauty 
that  distinguishes  her  from  her  miore  robust  sis- 
ters. I  know  a  famous  animal  painter  who  will 
always  unconsciously  select  from  a  herd  of  cows 
the  scrofulous  one  for  his  study  whenever  he 
makes  a  study  of  a  single  animal  from  a  herd. 

*Read  before  the  New  York  Academy  of  Medicine,  April  18,  1889. 

25 


26        Human  and  Bovine  Tuberculosis. 

This  is  not  the  only  strange  feature  of  the  dis- 
ease. No  one  seems  to  be  afraid  of  it.  For  vears 
men  of  undoubted  scientific  abihty  have  been 
proclaiming  to  the  world  the  still  hardly  recog- 
nized fact  that  bacillar}^  phthisis  is  contagious, 
but  the  human  family  take  little  heed.  Further- 
more, the  individual,  sorely  afflicted,  beyond  hu- 
man aid,  and  shortly  to  die,  is  not  convinced  of 
the  fact,  but,  with  the  same  strange  fatality  that 
surrounds  the  disease  in  all  its  phases,  the  con- 
sumptive it  still  hopeful  and  imagines  he  is  get- 
ting better  even  while  he  is  dying. 

This  insidious  and  delusive  disease  is  not  the 
result  of  civilization,  as  many  suppose.  Barbar- 
ous and  uncivilized  races  are  afflicted  as  severely 
as  many  of  the  most  advanced  civilized  races. 
Neither  geographical  position  nor  clim.atic  con- 
ditions are  a  factor  in  the  distribution  of  pulmon- 
ary phthisis,  notwithstanding  that  our  best  Avork- 
ers  in  the  study  of  the  disease  attempt  at  times  to 
account  for  its  prevalence  in  certain  localities  by 
reason  of  temperature  or  other  cHmatic  condi- 
tions. Nevertheless,  every  knovn  part  of  the 
elobe,  with  a  few  isolated  areas  excluded,  is  a 
habitat  of  the  disease.  After  several  years  of 
close  study  of  the  affection,  and  consulting  all 
accessible  statistics  and  the  habits  of  the  people 
where  the  disease  prevails,  the  only  constant  as- 


Human  and  Bovine  Tuberculosis.        27 

sociated  factor  is  found,  in  my  opinion,  in  the  in- 
bred Ijovine  species,  without  any  regrard  to  the 
social  position  of  a  community,  its  geographical 
habitation,  terrestrial  or  atmospheric  condition. 
If  a  community  is  closely  associated  with  inbred 
dairy  cattle,  tuberculosis  nrevails. 

This  position  which  I  take  is  susceptible  of 
strong  proof. 

In  establishing  my  proof  I  will  first  draw  your 
attention  to  some  barbarous  races  of  Africa. 
Speaking  of  the  natives  of  South  Africa,  P.  L. 
Simmonds,  in  his  book  on  "  Animal  Products," 
sa3^s:  ''This  people  delight  in  horned  cattle  of 
the  bovine  species,"  "  the  natives  are  great  milk 
drinkers,"  "  these  barbarous  people  suck  the 
blood  from  the  jugular  vein  of  the  hving  bul- 
lock," and  also  "  churn  together  blood  and  milk 
for  a  drink."  Professor  Low,  in  his  "  History  of 
the  Ox,"  tells  us:  "  In  the  vast  regions  of  south- 
ern Africa,  peopled  by  trii)es  of  warriors  and 
herdsmen,  cattle  abound  and  multiply,  and  form 
the  wealth  of  little  communities.  The  Hotten- 
tots, while  yet  they  had  a  countrv  they  could  call 
their  owm,  were  rich  in  this  kind  of  possession." 
In  Hirsch's  book  on  the  "  Geographical  Distribu- 
tion of  Phthisis  "  we  find  the  following:  "  In 
Cape  Colony  phthisis  is  oftenest  met  with  among 
the  Hottentots   inhabiting  the  plains  near  the 


28        Human  and  Bovine  Tuberculosis, 

coast."  In  proof  of  the  fact  that  these  African 
cattle  are  inbred,  we  have  the  writings  of  Ander- 
son, quoted  by  Darwin  as  follows:  ''  The  Dama- 
ras  take  great  delight  in  having  w^hole  droves  of 
cattle  of  the  same  color,  and  take  great  pride  in 
their  oxen  in  proportion  to  the  size  of  their  horns. 
The  Namaquas  have  a  perfect  mania  for  a  uni- 
form team,  and  almost  all  the  people  of  southern 
Africa  value  their  cattle  next  to  their  women,  and 
take  great  pride  in  possessing  animals  that  look 
high-bred."  Darwin,  from  whose  ''  Animals  and 
Plants  under  Domestication  "  we  take  this  quo- 
tation, adds  in  his  own  words:  "As  numerous 
breeds  are  generally  found  only  in  long-civilized 
countries,  it  may  be  w^ell  to  show  that  in  some 
countries  inhabited  by  barbarous  races,  who  are 
frequently  at  war  with  each  other,  and  therefore 
have  little  free  communication,  several  distinct 
breeds  of  cattle  now  exist,  or  formerly  existed, 
at  the  Cape  of  Good  Hope.  Lignat  observed  in 
1720  three  kinds;  at  the  present  day  (1868)  vari- 
ous travelers  have  noticed  the  difference  of  the 
breeds  in  southern  Africa.  Sir  Andrew  Smith 
several  years  ago  remarked  to  me  that  the  cattle 
possessed  by  the  different  tribes  of  Kaffirs, 
though  living  near  each  other  under  the  same 
latitude  and  in  the  same  kind  of  country,  yet 


Human  and  Bovine  Tuberculosis.        29 

differed,  and  he  expressed  much  surprise  at  the 
fact."  * 

These  facts  relating  to  the  cattle-breeding  pro- 
pensities of  the  negroes  account  for  the  state- 
ments of  Daniell,  that  "  phthisis  is  widely  preva- 
lent and  very  malignant  among  the  negroes  of 
the  west  coast  of  Africa."  In  the  interior  plat- 
eaus of  southern  Africa  phthisis,  hov/ever,  hardly 
ever  occurs.  This  immunity  can  be  accounted 
for  by  the  presence  of  the  tsetse  fly.  This  fly  in- 
habits well-defined  regions  in  central  Africa,  and 
where  it  exists,  cattle,  horses,  and  dop"s  can  not 
live.f 

Let  us  now  take  the  civilized  inhabitants  of  a 
colder  clim.e,  and  we  find  that  in  Denmark,  one 
of  the  noted  dairy  countries,  there  are  1,470,078 
cows  to  2,  033,959  inhabitants,  or  one  cow  to 
I  5-14  inhabitant.  The  mortality  from  phthisis 
in  that  county  ranges  from  three  in  a  thousand, 
to  2 . 1  in  a  thousand.  Now  Iceland,  an  island 
belonging  to  the  King  of  Denmark,  where  the 
climatic  conditions  are  nearly  the  same,  has 
20,000  cows  to  80,000  inhabitants.  There  are  no 
definite  statistics  about  this,  but,  taking  the  most 

*Guiol  says  that  consumption  is  not  uncommon  among  the  colored  races, 
particularly  the  Kaffirs.  Guiol,  "Archives  gin.  de  medecine,"  November, 
1882,  p.  329. 

t Wallace,  "The  Geographical  Distribution  of  Animals,"  1876,  vol.  i, 
p.  945- 


30        Human  and  Bovine  Tuberculosis. 

trustworthy  accounts  of  the  island  as  a  guide,  this 
is  about  the  condition  of  affairs.  The  people  of 
Denmark  are  well-to-do,  and  can  use  for  them- 
selves more  of  their  dairy  productions,  while  the 
poor  Icelander  pays  his  rent  with  his  dairy  pro- 
duct. With  the  exception  of  milk,  the  Icelander 
uses  very  little  from  his  herd  for  food.  In  several 
accounts  of  travelers  in  that  country  giving  a  de- 
scription of  the  entertainment  extended  to  them, 
I  never  find  beef  in  a  single  instance,  while  in  the 
winter  nearly  all  the  milk  used  is  obtained  from 
the  sheep.  Owing  to  the  short  hay  crops,  the 
cows  are  fed  in  winter  on  dried  fish,  and  conse- 
quently the  cattle  will  not  give  milk  on  the  same 
low  diet  as  the  sheep  do.  With  all  these  modify- 
ing influences,  and  only  one  cow  to  four  individ- 
uals, the  rarity  of  phthisis  in  the  island  can  be 
accounted  for,  if  my  theory  is  correct.  That  the 
disease  is  rare  v/e  know  from  the  v/ritings  of  Sch- 
leisner,  who  says:  '' Accordino-  to  the  unani- 
mous testimony  of  practitioners  on  the  island, 
consumption  does  indeed  occur  there,  although 
remarkably  seldom.  In  my  own  practice  I  have 
m.ost  carefully  examined  every  patient  who  com- 
plained of  even  the  slightest  trouble  in  the  chest, 
and  out  of  327  persons  suffering  from  chronic 
diseases  of  the  organs  of  respiration,  I  found  only 
three   with   phthisis."      Evans    says   that    ''  this 


Human  and  Bovine  Tuberculosis.         31 

statement  is  borne  out  by  the  more  recent  writ- 
ings on  the  state  of  heahh  in  Iceland,  by  Learecl, 
Hjaltlin,  and  Finsen.  It  would  appear  that  it  is 
not  with  any  national  peculiarity  that  we  have 
here  to  do,  from  the  fact  that  Icelanders  who 
migrate  to  Denmark  fall  into  consumption  not 
infrequently."  "^ 

Now  let  us  look  into  the  afifairs  of  a  Httle  island 
in  the  Atlantic  Ocean  as  they  existed  68  years 
ago.  It  will  be  remembered  that  in  my  former 
paper  on  this  subject  I  made  the  statem.ent  that 
asses  and  goats  were  not  tubercular  animals. 
The  following  is  quoted  from  "  A  Description  of 
the  Island  of  Saint  Michael,"  by  John  W.  Web- 
ster, M.  D.,  1821:  "Every  family  in  Saint 
Michael  has  one  or  more  asses,  which  are  the 
principal  beasts  of  burden  in  common  use,  sub- 
sisting on  the  coarsest  kind  of  food;  the  females 
afford  considerable  milk,  which  is  sold  to  sick 
persons.  Although  the  island  is  so  well  stocked 
with  black  cattle,  sheep,  and  goats  as  to  allow 
considerable  exportation,  few  of  these  belong  to 
the  peasanty.  Cows  are  mostly  attached  to  the 
estates,  and  the  peasant  who  hires  a  farm,  in 
addition  to  a  certain  quantity  of  work  to  be  per- 
formed for  his  landlord,  is  required  to  take  charge 

♦Hirsch,  "  Handbook  of  Geographical  and  Historical  Pathology,"  1886, 
vol.  iii,  p.  177, 


^2        Human  and  Bovine  Tuberculosis. 

of  these,  and  convey  the  milk,  butter,  and  cheese 
to  town,  where  they  are  sold  for  the  benefit  of 
the  morgado,  and  the  poor  peasant  receives  no 
other  recompense  for  his  trouble  than  some  slight 
abatement  in  his  rent.  The  milk  is  carried  to 
tov/n  in  skins,  on  the  backs  of  asses,  but,  from 
the  agitation  it  undergoes,  on  its  arrival  most  of 
the  families  in  the  city  prefer  using  the  milk  of 
the  goats,  herds  of  which  are  kept  in  the  vicinity, 
and  daily  driven  into  tow^n  and  miilked  at  the  door 
of  the  customicrs."  Dr.  Webster  adds:  "Al- 
though the  climate  of  St.  Michael  can  not  be 
safely  recommended  to  a  consumptive  patient, 
it  is,  nevertheless,  rare  to  see  the  disease  in  a  na- 
tive." Dr.  Webster  would  not  have  been  aston- 
ished at  this  condition  of  affairs  had  he  realized 
the  truth  that  phthisis  is  a  disease  acquired  from 
the  bovine  race,  for  it  is  a  fact  that  the  only  peo- 
ple on  the  face  of  the  globe  who  enjoy  an  abso- 
lute immunity  from  phthisis  are  those  who  are 
not  in  possession  of  the  domestic  cov/.  Take,  for 
instance,  the  Kirghiz  on  the  steopes  of  Russia; 
these  people  consume  large  quantities  of  mare's 
milk  and  eat  the  flesh  of  horses  and  sheep;  but 
they  have  no  cows.  According  to  Dr.  Neftel  and 
other  authority,  a  case  of  phthisis  among  these 
people  was  never  known. ^     Likewise,  the  Es- 

♦  Maj'dell,  quoted  by  Williams. 


Human  and  Bovine  Tuberculosis.        33 

quimanx  also  enjoy  immunitv,  because  they  have 
domesticated  the  reindeer,  not  the  cow. 
-  But  this  allusion  to  the  Esquimaux  does  not 
apply  to  those  who  inhabit  Greenland  and. that 
part  of  the  Danish  dominions  in  the  Artie  region. 
There  are  Esquimaux  that  knoAv  not  the  cow  and 
there  are  Esquimaux  who  have  domesticated  the 
cow.  So  there  are  authorities  that  state  that  the 
Esquimaux  are  exempt  from  phthisis,  and  other 
authorities  equally  as  positively  state  that  ''  con- 
sumption is  common  "  ^  among  them.  Thus,  in 
the  government  list  of  mortality  for  the  province 
of  Julianshaab,  ''  forty-six  persons  died  (out  of 
a  population  of  4,115,  Esquimaux  and  mixed 
breeds)  of  diseases  of  the  chest,  which  include 
phthisis,  pneumonia,  bronchitis,  pleuritis,  etc."  t 
This  prevalence  of  tuberculosis  is  perfectly  ex- 
plained by  the  facts  given  in  Dr.  Hayes's  book, 
"  The  Land  of  Desolation."  i  He  writes  in  his 
visit  to  Julianshaab:  "  Around  the  lake  were  ex- 
tensive pasture  grounds,  upon  which  were  brows- 
ing a  herd  of  cows  ...  At  this  I  was  not  a  little  sur- 
prised, for,  although  I  knew  that  in  former  times 
cattle  had  been  reared  here  in  great  numbers,  I 
had  received  the  impression  that  at  the  present 

*  Williams,  "Influence  of  Climate  in  Pulmonary  Consumption,"  p.  17. 

t  Ibid.,  p.  16. 

X  Dr.  Hayes,  "  Land  of  Desolation,"  p.  36. 

3 


34        Human  and  Bovine  Tuberculosis. 

time  they  would  not  thrive.  Mr.  Arthur  in- 
formed me  there  was  no  difficulty  in  raising  them, 
except  the  very  important  one  of  forage  for  the 
winter,  for  at  Julianshaab  the  grass  never  grows 
high  enough  for  hay;  further  up  the  fjord,  how- 
ever, it  is  abundant.  But  since  the  hay  must  all 
be  brought  in  boats,  it  was  both  a  tedious  and 
expensive  operation  to  gather  it.  Yet  he  man- 
aged to  keep  three  cows,  the  governor  had  an 
equal  number,  the  doctor  had  two,  others  had 
each  one;  and,  indeed,  all  the  well-to-do  people 
in  the  village — Danes,  half-breeds,  and  the  better 
class  of  Greenlanders — had  a  daily  supply  of  milk 
the  year  round."  Therefore,  according  to  this 
testimony,  the  average  of  dairy  cattle  in  this  com- 
munity is  higher  than  in  many  better-known  lo- 
calities, and  the  prevalence  of  phthisis  is  not  at  all 
surprising. 

Now  let  us  look  at  a  locality  which  once  en- 
joyed immunity  but  now  is  notoriously  a  place 
for  consumption.  Wallace,  in  his  work  on  "  The 
Geographical  Distribution  of  Animals,"  tells  us 
that  Australia  was  the  poorest  zoological  region 
on  the  globe.  A  story  is  told  by  Simmonds  as 
follows,  which  illustrates  the  scarcity  of  animals 
in  this  region:  "  Mr.  Oldfield,  who  has  seen  so 
much  of  the  aborigines  of  Australia,  informs  me 
that  they  are  all  very  glad  to  get  a  dog,  and  several 


Human  and  Bovine  Tuberculosis.         35 

instances  have  been  known  of  the  father  kilUng 
his  own  infant  in  order  that  the  mother  might 
suckle  the  much-prized  puppy."     The  only  ani- 
mals that  existed  in  this  island  before  its  invasion 
by  Europeans  were,  according  to  Wallace,  a  few 
marsupials.     Previous  to  1788  no  ruminants  ex- 
isted in  /Vustraha.     In  that  year  1,030  convicts 
and  sailors  v^ere  landed;  they  had  with  them  as 
public  stock  one  bull,  four  covvS,  one  calf,  one 
stallion,  three  mares,  and  three  colts.     In  1790 
provisions  gave  out,  and  they  were  obliged  to 
kill  all  the  live  stock  they  possessed.    In  1796  two 
bulls  and  three  cows  of  the  Cape  of  Good  Hope 
breed  were  introduced,  but  they  escaped  and  fled 
into  the  interior,  where  they  were  lost  for  several 
years.     During  this  year  several  attempts  were 
made  to  introduce  European  cattle,  but  they  all 
died  on  the  passage.     In  1807  the  Government 
had  a  herd  of  cattle  in  the  colony,  and  cows  were 
worth  $400  a  piece.     In  1821,  the  government 
becoming-  convinced  of  the  great  advantages  of 
Australia  as  a  grazing  country,  emigrants  were 
allowed  a  grant  of  from  500  to  2,000  acres  of 
grazing  land,  and  rations  from  the  King's  stores 
vrere  also  allowed  to  each  settler;  a  certain  num- 
ber of  convict  servants  were  likewise  apportioned 
to  them.    They  were  also  allowed  a  certain  num- 
ber of  cattle  from  the  government  herd,  and  a 


36        Human  and  Bovine  Tuberculosis. 

loan  of  money  to  be  repaid  in  seven  years.  This 
was  the  beginning  of  the  cattle  raising  in  Au- 
stralia. It  proved  so  successful  that  in  1826  the 
Australian  /\gricultural  Company  commenced  its 
operations,  which  was  the  origin  of  the  "  sJiecp 
and  cattle  manias  and,  as  the  historian  puts  it, 
''  the  priest  forsook  his  altar  and  became  a  herds- 
man of  cattle."  A  drought,  beginning  in  1827, 
and  lasting:  for  three  vears,  cured  the  mania.  But 
within  a  year  after  the  drought,  cattle  became  so 
plentiful  that  the  meat  of  the  best  quality  was 
sold  at  a  cent  and  a  half  a  pound.  In  1833,  good 
cattle  could  be  bought  for  $4  or  $5  a  head.  At 
the  present  time,  or  according  to  the  last  con- 
sular reports,  there  are  3,000,000  inhabitants  and 
8,000,000  cattle — nearly  three  animals  to  each  in- 
dividual. This  great  increase  will  be  seen  by  the 
foregoing  to  have  taken  place  w^ithin  60  years. 
Australia  enjoyed  a  reputation  for  immunity  from 
consumption,  and  the  favorable  influence  of  its 
climate  on  the  course  of  the  malady,  but,  as 
Hirsch  says,  ''  this  has  of  late  been  shown  to  be  a 
mistake.  In  Victoria."  he  continues.  ''  where  the 
disease,  it  is  true,  has  been  a  good  deal  more  com- 
mon only  in  recent  years,  the  mortality  from 
phthisis  in  1866,  was  6  per  cent,  of  the  mortaUty 
from  all  causes,  while  in  Melbourne  itself,  the 
death-rate  rose  between  1865  and  1869  from  2 .  22 


Human  and  Bovine  Tuberculosis.         37 

to  2  .  52  to  a  thousand  of  the  population.  In  New 
Zealand  phthisis  has  made  frightful  ravages 
among  the  Maoris,  and  has  been  one  of  the  chief 
causes  of  the  gradual  extinction  of  that  race." 
In  my  opinion,  the  death-rate  from  phthisis  will 
keep  on  increasing  in  that  locality  if  the  breeding 
of  cattle  is  not  properly  regulated  by  law.  We 
know  from  other  historical  facts  that  cattle  can 
be  raised  without  this  great  danger,  because 
Hirsch  and  others  tell  us  that  in  the  Hebrides,''' 
the  Highlands  of  Scotland,  iand  North  Wales 
consumption  is  remarkably  rare.  The  rarity  of 
the  disease  in  these  localities  is  accounted  for  by 
Darwin's  observation  while  he  was  studying  the 
conditions  of  cattle  under  domestication.  He 
says:  "  So  with  the  mountain  cattle  of  North 
Wales  and  the  Hebrides  it  has  been  found  that 
they  could  not  withstand  being  crossed  with  the 
larger  and  more  delicate  lowland  breeds.  Our 
improved  heavy  breeds  of  cattle  could  not  have 
been  formed  on  mountainous  pastures."  Now, 
any  one  who  has  paid  much  attention  to  the  his- 
tory of  cattle  breeding  knows  that  the  improved 
races,  as  we  understand  them,  are  the  result  of 
the  closest  inbreeding.  The  rarity  of  the  disease 
in  mountainous  countries  also  explains  the  fol- 
lowing quotation  from  Hirsch:    "  Few  countries 

*  MacCormac,  "Brit.  Med.  Jour  ,"  1868,  ii,  p.  571. 


38         Human  and  Bovine  Tuberculosis. 

of  Europe  enjoy,  on  the  whole,  so  favorable  con- 
ditions as  Switzerland  in  respect  to  the  infre- 
quency  of  consumption,  the  figures  for  the  entire 
country,  according  to  Muller,  being  i  .  86  in  a 
thousand.  In  studying,  however,  the  statistics 
of  the  different  cantons,  we  find  the  mortality 
ranging  from  3  .  57  to  only  0.81.  We  know  that 
there  are  localities  in  this  mountainous  country 
where  Darwin's  oL)ser\'ations  respecting  moun- 
tain ]}reeds  would  explain  this  condition  of  facts. 
The  number  of  cattle  in  Switzerland  is  1,210,849, 
and  the  population,  2,906,750,  or  one  animal  to 
2  4-29  inhabitants.  Of  course,  too,  there  are  re- 
gions of  Switzerland  where  only  the  goat  can 
range.  We  find  from  the  official  returns'^  of  1866, 
that  there  were  375,482  of  these  animals  in  that 
country,  and  we  know,  from  the  reports  of  trav- 
elers,y  that  the  milk  from  the  goat  is  used  exclu- 
sively in  some  localities. 

Having  considered  the  conditions  of  some  bar- 
barous and  some  civilized  communities,  let  us 
now  look  at  the  semi-civilized  tribes  of  Madagas- 
car. Both  Hirsch  and  Evans, 1  quoting  Grenet, 
say  that  in  this  island  consumiption  is  as  common 
as  it  is  in  any  part  of  Europe,  and  rapidly  fatal. 
We  have  no  statistics  of  the  numbers  of  the  popu- 

*  Siramonds,  "Animal  Products,"  p.  56. 

t  Prime,  *'  Letters  from  Switzerland,"  p.  44. 

X  Hirsch,  op.  cii.,  vol.  iii,  p.  186. 


Human  and  Bovine  Tuberculosis.        39 

lation  or  of  the  cattle,  but  all  the  writers  who 
have  visited  the  country  speak  of  the  enormous 
herds  of  cattle,  and  say  that  the  principal  diet  of 
the  natives  is  meat,  milk,  and  rice.  The  principal 
occupation  of  the  Malagasy  is  the  raising  of  cat- 
tle, thousands  of  which  are  shipped  to  the  other 
islands  in  the  Indian  Ocean.  In  fact,  the  Island 
of  Mauritius,  with  its  mixed  inhabitants,  depends 
entirely  on  Madagascar  for  its  meat  supply.  The 
Rev.  William  Ellis,  describing  his  trip  from  Tam- 
atave  on  the  coast  to  the  capital,  a  distance  of 
about  300  miles,  tells  of  the  natives  presenting 
him,  at  the  end  of  every  few  miles'  journey,  with 
a  bullock,  while  the  Queen  herself,  as  a  token  of 
friendship,  presented  him  with  eleven.  He  also 
adds  that  the  natives  never  skin  their  animals, 
but  cut  them  up  and  eat  the  hide  as  well  as  the 
meat. 

We  have  well-authenticated  statements  re- 
specting another  semi-civilized  race,  the  natives 
of  Great  Kabylia,  who,  according  to  Hirsch  and 
Evans  and  other  authorities,*  enjoy  an  almost 
absolute  immunity  from  phthisis.  According  to 
the  best  authorities  I  could  consult  as  to  the  his- 
tory of  the  people,  there  is  no  evidence  of  the 
presence  of  the  bovine  tribe  among  them,  but 

*  Armand,  "  M^d.  et  hygiene  des  pays  chauds,' '  Paris,  1853,  p.  375.    Bor- 
theraud,  "M^d.  et.  hyg.  des  Arabes,"  Paris,  1855. 


40        Human  and  Bovine  Tuberculosis. 

they  possess  large  flocks  of  sheep  and  goats,  and 
each  family  has  usually  one  bufialo  ox  to  do  the 
plowing.'^  As  these  are  a  peculiar  people,  with 
peculiar  ideas  and  peculiar  habits,  not  calculated 
to  encourage  visits  from  European  invalids,  they 
retain  their  immunity  from  phthisis  to  the  pres- 
ent day.  But  not  so  with  their  neighbors,  the 
Algerians.  This  country,  having  been  occupied 
for  over  half  a  century  by  the  French,  has  been 
therefore  rendered  suf^ciently  civilized  to  offer 
an  asylum  for  European  invalids.  When  first  oc- 
cupied by  the  French,  the  country  was  exempt 
from  phthisis,  and,  of  course,  the  publication  of 
this  fact  drew  to  it  many  consumptive  invalids. 
The  dairy  cow  was  unknown  in  Algiers  before 
the  French  conquest.  There  were  innumerable 
herds  of  buffalo,  indeed;  but  the  French  in  vain 
offered  a  premium  of  fifty  francs  a  head  for  the 
importation  of  dairy  stock.f  Up  to  1854  they 
w^ere  unsuccessful,  all  these  attempts  proving  fu- 
tile. In  the  latest  statistics  from  that  country  we 
find  the  largest  proportion  of  deaths  from  phthisis 
among  the  European  civil  residents. t 

Dr.  Scoresby  Jackson  makes  the  following  re- 
mark about  Algiers:     "It  is  not  necessary  to 

•  Daumas,  "La  Grande  Kabylie."     Morell,  "Algeria,"  1854. 

t  Morell,  "  Algeria,"  p.  477. 

$  Jackson,  "  Medical  Climatology,"  p.  138. 


Human  and  Bovine  Tuberculosis.        41 

prove  the  absence  of  pulmonary  consumption 
from  the  natives  of  a  country  in  order  to  demon- 
strate the  beneficial  influence  of  its  cHmate  upon 
those  so  affected  from  other  countries.  It  would 
be  difficult  to  find  such  a  place,  .  .  .  but  Algiers, 
at  all  events,  approximates  such  a  condition." 

There  are  many  other  countries  furnishing  sta- 
tistics of  death-rate  from  phthisis  where  the  dis- 
ease is  not  indigenous  but  due  to  importation.  I 
think  this  can  be  said  of  Greece.  According  to 
Roser'''  and  Olympios,  the  disease  is  very  rare  in 
that  country,  and  Edmond  About,  in  his  book 
on  ''  Greece  and  the  Grecians,"  tells  us  that  "  the 
town  of  Athens  possesses  only  five  or  six  cows; 
no  other  milk  is  drank  than  that  of  the  sheep; 
their  butter  alone  is  eaten.  They  eat  meat  but 
once  a  year.  The  entire  population  eats  meat  at 
Easter  for  the  whole  year,  f  and  this  meat  is 
lamb,  t 

In  studying  the  relations  existing  between  the 
human  and  the  bovine  races  I  find  that  religion 
plays  a  prominent  part.  Thus,  in  India,  with  the 
Mohammedan,  Brahmin,  and  Buddhist  religions, 
but  where,  as  a  rule,  dairy  cattle  have  not  been 


*Roser,   "  Ueber    einige    Krankheit.   des  Orients,"   p.   79.     Olympios, 
"  Corresp.  bayerischer  Aerzte,"  p.  i8t. 
t Edmond  About,  "Greece  and  the  Grecians,"  p.  33. 
X  Ibid.^  p.  102. 


42        Human  and  Bovine  Tuberculosis. 

domesticated,  there  was  undoubtedly  an  absence 
of  phthisis  before  the  English  occupation.  Hence, 
to-day  we  find  all  statements  regarding  the  pres- 
ence of  tuberculosis  uncertain.  Thus  Hirsch''' 
says:  "  So  also  in  India  the  prevalence  of 
phthisis  can  not  be  given  in  figures.  It  is,  on  the 
whole,  rarer  in  that  part  of  the  vv'orld  than  in  the 
temperate  zone  of  the  Eastern  Hemisphere,  but 
by  no  means  so  rare  as  the  earlier  observers  sup- 
posed from  their  imperfect  means  of  diagnosis.'' 
Now,  here  is  that  expression  of  the  feeling  of 
doubt  and  uncertainty  which  we  find  in  many 
works  relating  to  this  elusive  disease.  A  man 
of  scientific  ability  goes  to  a  country  and  fiends  no 
phthisis  among  the  inhabitants.  After  some 
years,  under  circumstances  that  change  the  habits 
of  the  people,  he  begins  to  find  phthisis,  and 
therefore  imagines  he  was  mistaken  in  his  first 
observations.  We  find  this  taking  place  in  Au- 
stralia, Algiers  and  Greenland.  In  India  this  va- 
cillating expression  of  doubt  is  easily  accounted 
for.  When  the  English  first  occupied  the  coun- 
try, the  only  cow  they  had  was  the  small  Hindoo 
variety,  not  related  to  our  dairy  cow,  and  this 
animal  was  and  is  an  object  of  veneration,  and 
the  milk  used  in  the  country  was  derived  from 

*  Hirsch,  op.  cit.^  vol.iii,  p.  185. 


Human  and  Bovine  Tuberculosis.         43 

the  buffalo.  All  the  Buddhists  and  many  of  the 
Brahmin  castes  abstain  from  the  use  of  meat  in 
any  form.  Ansell,  an  early  writer,  says:  "  It 
appears  that  tuberculosis  is  correspondingly  non- 
existent in  certain  localities  in  India."  Now, 
there  is  a  constant  change  always  taking  place 
in  such  a  country  as  India.  Prejudices  are  dying 
out,  and  many  of  the  people  have  undoubtedly 
adopted  the  habits  of  their  conquerors.  The 
English  dairy  cow  is  slov\dy  but  surely  finding  her 
way  into  India,  or,  as  Mair,  a  deputy  coroner  of 
Madras,  says:  "  Beef  is  not  at  all  times  procur- 
able, but  is  generally  sold  about  once  a  v/eek  in 
every  station  where  there  is  a  sufficient  number 
of  Europeans  to  render  the  slaughter  of  an  ani- 
mal w^orth  the  butcher's  while,  for  little  beef  is 
used  among  the  natives.  Occasionally  the 
slaughter  of  a  fine  English  stall-'fed  cow  is  adver- 
tised. In  some  districts  the  sale  of  beef  is  pro- 
hibited by  law,  out  of  respect  for  caste  prejudices. 
Butter  is  an  article  difficult  to  procure  of  good 
quality,  except  on  the  hills,  wdiere  it  is  sold  by 
European  settlers,  who  make  dairy  keeping  con- 
tribute to  their  support.  The  native  tendency  is 
to  palm  off  buff'alo  butter  for  that  made  of  cow's 
milk."  There  is  little  doubt  that  when  the  Eng- 
lish dairy  system  becomes  well  established  in  In- 
dia, the  statistics  of  phthisis  will  be  uniform  and 


44        Human  and  Bovine  Tuberculosis. 

undoubtful.  Of  course,  the  Buddhists  and  the 
Brahmins  will  be  the  last  to  adopt  the  dairy  cow 
as  a  food  producer. 

Geographical  and  climatic  conditions  have 
little,  then,  to  do  with  the  prevalence  of  tubercu- 
losis. There  are  undoubtedly  conditions  of  cli- 
mate, habitation,  etc.,  that  favor  the  development 
of  the  disease,  if  the  contagium  is  present;  and 
the  contagion,  I  think,  is  always  derived  pri- 
marily from  the  dairy  cow.  The  Kirghiz  inhabit- 
ing the  steppes  of  Russia,  lOO  feet  below  the  sea- 
level,  with  a  rigorous  clime,  intensely  cold  win- 
ters and  warm  summers,  badly  housed  and  fed 
during  the  long  months  of  cold  weather,  no  dairy 
cows,  and  an  entire  absence  of  phthisis.  Take, 
as  nearly  as  we  can  get,  a  diametrically  opposite 
geographical  and  climatic  condition,  and  we  find 
Quito,  the  highest  city  in  the  world,  situated  lo,- 
Goo  feet  above  the  sea-level,  located  at  the  equa- 
tor. "  No  torrid  heat  enervates  the  inhabitant  of 
this  favored  spot,  no  icy  breeze  sends  him  shiver- 
ing to  the  fire."  "  The  mean  annual  temperature 
is  58°,  the  extremes  45°  and  70°  Fahr.""^  Now, 
we  have  quite  positive  and  authoritative  state- 
ments regarding  this  city.  Professor  James  Or- 
ton,  of  Vassar  College,  who  made  a  scientific  ex- 

*  Orton,  "  Andes  and  Amazon,"  p.  92. 


Human  and  Bovine  Tuberculosis.        45 

pedition  to  the  equatorial  Andes  in  1867,  under 
the  auspices  of  the  Smithsonian  Institution,  says, 
at  Quito,  "  suddenly  we  are  looking  down  into 
the  valley  of  Chimbo;  there  are  herds  of  cattle 
and  fields  of  grain,  yet  we  shall  not  find  a  quart 
of  milk  or  a  loaf  of  bread  for  sale.  Thousands  of 
cattle  are  raised  on  the  Paramos,  but  almost 
wholly  for  beef.  A  disHke  to  milk  (observed  by 
Humboldt),  or  at  least  an  absence  of  its  use  be- 
fore the  arrival  of  Europeans,  was,  generally 
speaking,  a  feature  common  to  all  natives  of  the 
new  continent.  Some  cheese,  mostly  unpressed 
curd,  and  a  Httle  butter,  are  made,  but  in  the  pa- 
triarchal style;  only  one  American  churn  is  in 
operation  (in  Quito,  with  a  population  of  80,000). 
The  people  insist  on  first  boiling  the  milk,  and 
then  stirring  it  with  a  spoon ;  custom  is  omnipo- 
tent here,  and  its  effect  is  hereditary."  Professor 
Orton  further  says:  ''  Consumption  is  unknown 
in  the  city."  The  testimony  is  unanimous  that 
phthisis  does  not  exist  in  Quito,  but  on  the  plains 
in  Ecuador,  according  to  Dr.  Archibald  Smith, 
who  practiced  there  for  25  years,  ''  the  disease  is 
not  uncommon." 

Professor  Orton,  after  leaving  Quito  and 
traveling  toward  the  Amazon,  makes  the  follow- 
ing observation,  which  clearly  indicates  that  the 
dairy  cow  exists  in  other  parts  of  this  country: 


46        Human  and  Bovine  Tuberculosis. 

"  The  following  day  we  advanced  five  miles  to 
Tablon,  an  Indian  hamlet  on  the  mountain-side. 
There  we  waited  over  night,  and  this  was  the 
only  spot  in  South  America  where  we  found  milk 
to  our  stomachs'  content." 

Without  going  into  further  details  respecting 
separate  communities,  let  us  consider  the  statis- 
tics of  Europe,  and  there  v/e  find  that  the  preval- 
ence of  phthisis  is  regulated  by  the  ratio  of  the 
bovine  to  the  human  race.  Thus,  in  Ireland, 
Vv'here  the  cattle  number  4,570,000,  nearly  an 
equal  proportion  to  that  of  the  inhabitants,  ac- 
cording to  Dr.  Wylde,  phthisis  is  by  far  the  most 
fatal  affection  to  which  the  inhabitants  of  that 
country  are  subject.  Denmark,  with  about  the 
same  ratio  of  cattle  to  inhabitants,  sustains  about 
the  same  rate  from  consumption.  In  Portugal, 
where  there  are  six  inhabitants  to  one  bovine  ani- 
mal, consumption  attracts  so  little  attention  that 
fevv^  notices  can  be  found  relating  to  the  disease 
in  that  country.  In  Italy,  the  distribution  of 
cattle  being  one  to  six  inhabitants,  the  mortality 
from  phthisis  varies  greatly  in  different  parts  of 
the  country,  reaching  the  exceedingly  low  rate  of 
0.86  in  a  thousand  in  the  Basilicata.  In  Egypt, 
where  the  ratio  is  one  animal  to  nearly  thirty  in- 
habitants, Pruner  tells  us  "  that  the  disease  be- 
comes less  in  exact  proportion  as  we  proceed 


Human  and  Bovine  Tuberculosis.        47 

southward  from  the  shore  of  the  Mediterranean. 
In  Central  and  Upper  Egypt  it  is  decidedly  un- 
common."* 

Thus  the  statistics  go  on,  and  where  the  excep- 
tions arise,  the  cause  is  always  evident  in  the  con- 
ditions that  influence  the  breeds  of  cattle.  Tak- 
ing into  consideration  all  the  foregoing  facts, 
there  can  be  little  doubt  that  the  inbred  species 
of  the  bovine  race  is  the  prime  aetiological  factor 
of  phthisis  in  the  human  race.  They  not  only 
nurse  the  germ  and  prevent  its  extinction,  but 
sow  it  in  the  human  race  continually  and  abund- 
antly; without  their  aid  the  germ  would  die,  for 
of  all  the  germs  known  none  have  so  hard  a 
struggle  for  existence  in  the  human  kind  as  the 
bacillus  of  tubercle,  when  we  consider  the  com- 
paratively few  of  the  human  race  who  are 
afflicted,  and  the  immense  number  who  are  ex- 
posed to  the  infection  and  escape  it. 

Up  to  the  present  writing  the  cow  is  the  only 
known  animal  that  has  transmitted  tuberculosis 
to  her  offspring  in  inheritance,  and  even  here  we 
have  only  one  case.  I  am  fully  aware  that  this 
statement  will  meet  with  considerable  opposition, 
as  many  of  our  best  workers  are  of  opinion  that 
bacillary  phthisis  is  hereditary  in  the  human  race. 

•  Hirsch.p.  192. 


48        Human  and  Bovine  Tuberculosis. 

But  I  have  concluded  that  this  is  merely  a  theory, 
because,  after  diligent  search,  I  have  failed  to  find 
a  well-authenticated  case  on  record  of  a  human 
foetus  at  term  showing  evidence  of  tuberculosis. 
We  have,  however,  on  record  in  the  "  Fortsch- 
ritte  der  Medizin,"  No.  7,  vol.  iii,  1885,  a  case 
given  by  Johne  of  congenital  tuberculosis  in  a 
foetal  calf  of  eight  months,  and  in  Crookshank's 
''  Manual  of  Bacteriology  "  (plate  18)  is  a  stained 
illustration  of  the  bacilli  from  this  undoubted 
case.  Just  in  the  line  of  this  hereditary  tendency 
let  me  narrate  an  experiment  of  my  own.  Last 
summer  I  took  the  entire  lungs  and  all  the  largely 
involved  lymphatic  glands  from  a  cow  dead  from 
acute  miliary  tuberculosis,  and,  confining  five  lay- 
ing hens  and  a  cock,  fed  them  exclusively  on  this 
matter  till  it  was  all  consumed.  I  found  after 
eight  days  one  of  the  hens,  which  I  killed,  had 
tubercular  afTection  of  the  laryngeal  glands;  I 
took  twenty-six  of  the  last  e^^^s  laid  by  these 
hens  and  put  them  under  two  setting  hens  in  an- 
other part  of  the  farm.  Twenty- three  of  these 
eggs  developed  foetal  chicks,  but  not  a  single  one 
lived  to  come  out  of  the  shell.  Two  or  three  days 
after  the  period  of  incubation  had  expired,  the 
hens  themselves  broke  the  eggs,  but  every  chick 
was  dead.  I  took  some  of  the  ep-p-s  that  I  had 
not  used  for  setting  to  the  Carnegie  laboratory, 


Human  and  Bovine  Tuberculosis.        49 

and  Dr.  Grauer  searched  diligently  for  the  bacil- 
lus tuberculosis,  but  failed  to  find  any.  He  found, 
however,  the  presence  of  the  germ  in  the  lym- 
phatic glands  of  the  hen  I  had  killed;  he  now  has 
some  of  the  chicks,  but  I  have  received  no  report 
from  him  as  to  their  condition.  Of  the  four  re- 
maining hens  and  cock,  some  one  stole  the  latter 
when  he  was  apparently  quite  ill,  three  of  the  hens 
died  extremely  emaciated,  notwithstanding  that 
they  had  abundance  of  good  food  after  they  had 
finished  the  tuberculized  matter,  and  the  remain- 
ing hen  was  killed  by  the  burning  of  the  building 
in  which  she  was  confined.  This  experiment 
needs  confirmation  by  further  experimentation. 
I  had  no  idea  that  the  eggs  would  not  mature, 
or  I  should  have  placed  with  them  under  the  same 
hens,  eggs  from  healthy  birds;  there  w^as  no  ap- 
preciable cause  in  the  surroundings  or  other  con- 
ditions to  prevent  the  hatching  except  the  before- 
mentioned  tubercular  condition  of  the  layers.  I 
shall  repeat  this  experiment,  using  eggs  from 
healthy  birds  with  those  from  tuberculous  layers. 
Without  knowing  that  the  fact  is  so,  I  have 
been  looking  up  statistics  of  zoological  gardens, 
and  find  that  tuberculous  animals  fail  to  breed 
w^hile  in  confinement.  Of  course  we  have  no 
means  of  knowing  how  they  behave  themselves 
in  their  wild  state,  but  I  feel  pretty  safe  in  as- 
4 


50        Human  and  Bovine  Tuberculosis. 

serting  that  no  one  ever  found  a  wild  animal  with 
tuberculosis.  Darwin's  statement  while  writing 
on  inheritance — "  that,  unfortunately,  it  matters 
not,  as  far  as  inheritance  is  concerned,  how  in- 
jurious a  quality  or  structure  may  be  if  compat- 
ible with  life  " — only  applies  to  the  human  race 
and  animals  which  the  human  race  is  instrumen- 
tal in  breeding.  To  such  animals,  bred  by  the 
human  race,  Darwin  applies  the  term  artificial. 
We  all  knovv^  that  in  cattle  one  that  is  injured  or 
unable  to  follow  the  herd  is  killed  by  the  herd, 
and  1)ulls  in  their  wild  state  only  maintain  their 
supremacy  by  their  vigor.  The  moment  the  head 
of  a  herd  suffers  from  age  or  disease  he  is  put 
away  by  the  next  strongest,  and  thus  the  vigor 
of  the  herd  is  preserved  by  this  law  of  the  survival 
of  the  fittest. 

Man  can  not  generate  new  forms,  but  he  can 
so  control  and  interfere  with  nature's  processes 
as  to  modify  the  original  design.  Inbred  cattle 
are  selected,  sheltered,  and  pampered,  as  they 
would  be  unable  to  withstand  the  rigorous  condi- 
tions of  the  wild  state;  they  propagate  earlier  and 
are  larger  milkers  and  more  efficient  beef  pro- 
ducers, and  their  meat  is  more  delicate  and  tender 
than  that  of  the  wild  animal.  All  this  is  achieved 
by  man  at  the  expense  of  his  own  health. 


[Reprinted  from  "The  New  York  Medical  Journal,"  March  8,  1890.] 

ON  THE  COINCIDENT  GEOGRAPHICAL 
DISTRIBUTION    OF    TUBERCULO- 
SIS  AND    DAIRY    CATTLE.* 

If  it  can  be  shown  by  reputable  authorities 
that  the  geographical  distribution  of  inbred  dairy 
cattle  is  coincident  with  the  geographical  dis- 
tribution of  human  tuberculosis,  there  is  a  rea- 
sonable presumption  that  these  phenomena 
stand  to  each  other  in  the  relation  of  cause  and 
effect.  I  am  well  aware  that  the  doctrine, 
started  by  Wells,  that  malarial,  diseases  are  an- 
tagonistic to  pulmonary  consumption,  appeared 
so  plausible  on  its  first  announcement  that  sev- 
eral other  scientific  men  adopted  the  theory,  and 
even  at  the  recent  congress  for  the  study  of  tu- 
berculosis, held  in  Paris,  the  doctrine  was  again 
advanced  by  De  Brun,  of  Beyrout,  and  sustained 
by  Picot,  of  Egypt,  after  it  had  been  entirely 
abandoned  by  such  men  as  Hirsch  and  others, 
who,  Hke  him,  had  made  the  whole  inhabitable 
earth  their  field  of  observation.  This  theory, 
like  many  another  weak  theory,  was  based  on 

*  Read  before  the  Medical  Society  of  the  State  of  New  York  at  its  eighty- 
fourth  annual  meeting. 

SI 


52  Distribution  of  Tuberculosis. 

observations  confined  to  a  limited  area  and  a 
limited  length  of  time.  To  avoid  this  error,  it 
has  been  my  endeavor  to  extend  my  observa- 
tions to  every  known  inhabited  portion  of  the 
globe,  and  to  all  periods  of  time,  recent  or  re- 
mote; for  it  is  impossible  to  study  a  disease  Hke 
tuberculosis  without  a  proper  understanding  of 
all  the  changes  that  have  taken  or  are  taking 
place  in  each  country,  because  tuberculosis  is 
slower  and  more  uncertain  in  its  development 
than  the  other  common  contagious  or  infectious 
diseases.  One  of  the  greatest  disturbing  ele- 
ments I  have  found  in  the  study  of  the  geograph- 
ical distribution  of  tubercular  consumption  is  in 
the  medical  reports  of  the  British  army  and  navy, 
because,  in  countries  enjoying  an  immunity  from 
this  disease  previous  to  the  invasion  of  these 
forces,  many  of  the  invaders,  after  the  invasion, 
suffer  from  an  attack,  and  often  die  from  pulmo- 
nary consumption  which  they  had  acquired  be- 
fore leaving  their  native  land;  and  consequently 
the  statistics  show  deaths  from  pulmonary 
phthisis  in  the  country,  and  thus  rob  it  of  its 
reputation  for  immunity,  notwithstanding  the 
fact  that  the  natives  themselves  retain  their  ex- 
emption. This  fact  may  be  alleged  as  a  refuta- 
tion of  the  popular  theory  of  the  day — that  cli- 
matic conditions  stand  in  a  causative  relation  to 


Distribution  of  Tuberculosis.  53 

tubercular  consumption,  for  many  advocates  of 
this  theory  imagine  (consistently,  if  the  theory 
were  correct)  that  where  climatic  conditions 
form  an  aetiological  factor,  all  residents  of  a 
country  enjoying  imimunity  by  reason  of  its  cli- 
mate would  be  exempt.  This  is  not  so.  Only  those 
who  are  not  infected  are  exemipt;  consequently 
we  must  look  for  some  source  of  infection.  Un- 
doubtedly climatic  and  hygienic  conditions 
favor  the  development  of  the  disease  in  a  human 
subject  exposed  to  infection,  and,  therefore,  the 
first  and  greatest  question  for  us  to  answer,  if  we 
can,  is,  Whence  comes  the  contagion?  Is  it  in- 
digenous in  any  of  our  domestic  animals?  No 
one  denies,  when  a  humian  subject  suffers  from 
an  attack  of  glanders,  that  the  disease  was  ac- 
quired from  a  horse;  neither  do  we  question  the 
derivation  of  an  attack  of  hydrophobia  in  a 
humian  subject;  and  we  know  that  many  other 
diseases  are  directly  derived  from  some  of  our 
domestic  animals.  Now,  if  we  were  to  take  a 
single  country  like  our  own,  and  find  that  just 
in  proportion  as  dairy  cattle  abound  in  a  given 
community  so  does  tuberculosis  prevail,  this 
might  be  a  mere  coincidence;  but  if  we  take  the 
entire  world  and  find  the  same  existing  connec- 
tion between  the  tv/o,  these  accumulated  coin- 
cidences amount  to  a  presumption  that  the  con- 


54  Distribution  of  Tuberculosis. 

nection  is  that  of  cause  and  effect.  It  seems  to 
me  very  easy  to  settle  the  question  whether  the 
dairy  cow  does  derive  the  contagion  from  us,  as 
some  thoughtlessly  allege,  or  no.  The  only  pos- 
sible way  in  which  a  cow  could  acquire  the  con- 
tagion would  be  from  its  attendant,  and  surely, 
even  if  that  attendant  were  affected,  the  only 
thing  the  cow  could  derive  the  disease  from 
would  be  his  breath  or  his  sputa,  and  this  in  the 
proportion  of  one  man  to  fifteen  or  twenty 
animals;  the  attendants,  too,  may  or  may  not 
be  affected,  while  in  every  dairy  the  percentage 
of  animals  affected  by  tuberculosis  is  from  five 
to  twenty-five  per  cent.  Now,  the  danger  the 
other  way  is  straight  and  plain,  because  the 
human  subject  absorbs  the  entire  animal,  drink- 
ing its  secretion  while  this  lasts,  and  finally  eat- 
ing the  animal  up.  Further,  we  find  communi- 
ties without  pulmonary  tuberculosis  who  have 
not  dairy  cattle,  and  we  find,  also,  communities 
that  have  been  exempt  previous  to  the  introduc- 
tion of  dairy  cattle. 

Here  let  me  say  that  I  wish,  above  all  things, 
to  avoid  any  appearance  of  having  enlisted  in  the 
army  of  "  alarmists."  If  the  presence  of  tuber- 
culosis were  simply  a  danger  that  could  not  be 
avoided,  and  were  to  be  threatening  the  entire 
human  race,  as  many  would  have  us  believe,  it 


Distribution  of  Tuberculosis.  55 

would  be  better  to  let  the  question  alone  entirely. 
There  are  many  people,  both  professional  and 
lay,  who  cannot  take  a  calm  view  of  a  danger; 
they  must  either  approach  it  blindfold  or  else 
must  rush  from  it  with  screaming  terror  that 
alarms  every  one  within  their  hearing.  Thus, 
we  see  at  the  present  day  sanitarians  and  health 
authorities  urging  the  isolation  of  the  unfortu- 
nate consumptive,  the  destruction  of  his  clothing 
and  everything  connected  with  him,  seemingly 
assuming  that  the  human  race  itself  develops  the 
venom  that  is  destroying  it,  like  the  scorpion 
that  stings  itself  to  death.  I  do  not  attempt  to 
deny  that  it  is  possible  for  one  human  subject  to 
convey  the  infection  to  another,  but  I  think  this 
danger  very  remote  in  comparison  with  the  prime 
danger  of  bovine  infection.  If  we  take  countries 
like  Algiers  and  Egypt — where  the  tubercular 
bovine  is  still  absent,  but  the  human  consumptive 
present,  and  the  native  population  still  exempt — 
we  surel}^  see  that  the  danger  of  contagion  from 
human  to  human  is  not  imminent;  while,  on  the 
other  hand,  if  we  take  countries  like  Madeira, 
Australia  and  the  Sandwich  Islands,  we  find  very 
plainly  that  the  introduction  of  inbred  dairy  cat- 
tle tuberculanzes  the  natives.  I  do  not  mean  to 
imply  that  every  one  who  drinks  milk  from  tu- 
bercular cows  will  become  tubercular,  for,  if  this 


56  Distribution  of  Tuberculosis. 

were  a  fact,  instead  of  the  deaths  from  pulmonary 
consumption  forming  one-seventh  of  the  whole 
mortality,  the  great  majority  of  civilized  races 
would  have  become  extinguished  by  the  disease. 
I  have  know^n  many  cases  of  children  and  adults 
taking  for  3''ears  the  milk  of  tubercular  cows  and 
yet  exhibiting  no  symptoms  of  tubercular  infec- 
tion. We  must  ahvays  remember  that  some 
other  systematic  condition  is  necessary  as  well 
as  the  germ  for  the  development  of  this  disease; 
scrofulosis,  temperature,  certain  hygienic  or  cli- 
matic conditions  that  tend  to  lower  resistance, 
are  all  factors  in  the  causation  of  a  susceptibility 
to  infection.  This  susceptibility,  arising  from 
any  or  all  of  the  causes  enumerated,  may 
be  present  in  some  individuals  in  a  commu- 
nity, and,  unless  the  inbred  dairy  cow  is 
a  producer  of  food  for  that  community, 
these  cases,  be  they  more  or  less  numerous, 
will  not  suffer  from  tubercular  consumption. 
There  are  localities  with  a  rigorous  climate,  re- 
sulting from  their  altitude,  where  dairy  cattle 
cannot  be  closely  inbred,  because  inbred  cattle 
could  not  stand  the  severity  of  the  climate,  and 
they  are  not,  by  reason  of  their  breeding,  tuber- 
cular. Such  animals  are  not  deemed  by  the 
modern  breeder  as  the  best  dairy  animals,  for, 
requiring,  by  reason  of  their  vigor  and  robust- 


Distribution  of  Tuberculosis.  57 

ness,  more  of  the  food  that  they  consume  for 
their  own  nutrition,  they  have  less  of  this  food 
available  for  making  milk.  In  the  Highlands  of 
Scotland  and  the  Hebrides,  where  these  crea- 
tures abound,  the  countries  are  not  known  as 
dairy  countries,  neither  are  they  tubercular.  It 
is  significant  that  in  the  great  dairy  countries, 
such  as  England,  Ireland  and  Denmark — in  fact, 
wherever  the  dairy  is  one  of  the  national  indus- 
tries— the  prevalence  of  tubercular  consumption 
is  a  settled  fact,  which  requires  no  further  con- 
sideration on  our  part.  In  those  countries,  how- 
ever, where  there  is  no  settled  dairy  industry, 
and  the  habits  of  the  people,  are  opposed  to  the 
care  of  dairy  cattle,  the  prevalence  of  phthisis  is 
rare  or  entirely  absent.  It  is  only  in  these  coun- 
tries that  a  doubt  exists  as  to  the  extent  to  which 
phthisis  occurs. 

Now  let  us  look  at  China.  Here  is  a  nation 
peculiar,  to  our  notions.  The  reigning  dynasty 
and  high  officials  are  of  Tartar  blood;  the  bulk 
of  the  people  are  pure  Chinese.  Andrew  Wilson, 
who  made  a  trip  through  China  and  Thibet,  and 
published  his  book  in  1875,  says:  "  It  is  very 
extraordinary  that  ....  the  Chinese  should  so 
entirely  eschew  the  use  of  milk  in  every  shape; 
at  Lassa  the  pure  Chinese  do  not  take  any  milk, 
and  the  reason  they  gave  for  not  doing  so  was 


58  Distribution  of  Tuberculosis. 

that  milk  made  people  stupid.  The  Chinese  may 
have  got  this  idea  from  the  fact  that  the  Tartars, 
who  are  necessarily  milk  drinkers  and  eaters  of 
dried  ivAlk  and  buttermilk,  are  a  a- ery  stupid  peo- 
ple."* Pumpelly,  who  traveled  extensively  in 
China  under  the  auspices  of  the  government, 
says:  "Great  as  is  the  variety  of  food  in  the  Chinese 
cuisine,  some  things  are  missed  by  the  traveler — 
such  as  bread,  butter,  and  milk.  A  little  milk  is 
sold."t  The  same  v.Titer  adds,  respecting  the 
city  of  Pekin:  "  During  the  winter  months  this 
city  has  no  rival  in  the  world  in  the  abundance 
and  varietv  of  the  o;-ame  and  domestic  meats  with 
which  its  market  is  stocked.  It  receives  large 
quantities  of  good  beef  from  Mongolia."!  I  have 
abundance  of  testimony  to  the  same  effect,  as 
many  travelers  have  written  relating  to  this  coun- 
try. Of  course,  there  is  nothing  in  this  that  in- 
dicates how  their  cattle  were  bred,  or  how  much 
milk  they  consumed,  but  this  and  all  other  testi- 
mony emphatically  indicates  that  the  pure 
Chinese,  of  which  the  poorer  classes  are  entirely 
made  up,  do  not  drink  milk,  while  the  Tartars 
the  ruling  and  militar}-  class,  do  get  milk  and 
beef;  and   I  can  show  from  reputable  medical 


*  The  Abode  of  Snow,  New  York,  1875,  P-  i97- 

t  Across  America  and  Asia,  Nev/  York,  1870,  p.  302. 

*  Across  America  and  Asia,  p.  274. 


Distribution  of  Tuberculosis.  59 

authority  in  China  that,  of  these  two  classes, 
the  former  are  the  non-tubercular  when 
the  disease  shows  itself  in  that  country.  Thus 
Dr.  Wang,  a  Chinese  physician  educated  in  Edin- 
burgh, where  he  had  undoubtedly  been  taught 
that  climatic,  hygienic,  and  dietetic  conditions 
were  the  causes  of  pulmonary  consumption, 
writes  concerning  diseases  of  the  chest  in  China 
as  follows:  "  The  rarity  of  consumption  among 
the  country  people  and  the  greater  exemption 
from  it  of  the  laborinp-  class  in  the  citv,  notwith- 
standing  that  they  are  badly  housed  and  badly 
fed,  must  be  attributed  to  their  exercise  in  the 
open  air.  .  .  .  Still,  I  cannot  quite  understand 
why  phthisis  is  not  more  prevalent  than  it  is 
among  them,  especially  the  country  poor,  whose 
food  often  seems  not  more  than  half  sufficient  to 
support  life."  In  regard  to  Canton,  Dr.  Wang 
says:  "  Phthisis  is  tolerably  prevalent,  but  by  no 
means  so  common  as  in  Europe  and  America."* 
Of  course.  Canton  cannot  be  looked  at  like  the 
rest  of  China,  for  seaport  towns  are  af^icted  with 
imported  cases,  even  vvdien  the  disease  is  not  in- 
digenous. Dr.  Jamisonf  says:  ''  The  testimony 
of  all  foreign  practitioners  in  China  wdio  have 
written  on  the  subject  is  unanimous  as  to  the 

*  Dobell's  Reports,  voL  iii,  1877,  pp.  33,  34. 
t  Ibid.,  vol,  i,  1875,  p  283. 


6o  Distribution  of  Tuberculosis. 

rarit}^  of  phthisis  originating  here  among  foreign- 
ers; every  instance  of  chronic  phthisis  which  has 
come  under  my  care  has  been  imported."  Thus 
the  statistics  of  this  city  cannot  be  inckided  in 
the  history  of  the  disease  in  China.  We  see, 
then,  that  among  the  poorer  class  puhnonary 
consum.ption  is  absent  or  rare,  while  among  the 
better  class  of  Tartar  Chinese,  phthisis  is  not  an 
uncommon  disease.  Thus  Surgeon-General 
Gordon  dwells  on  "  the  frequent  occurrence  of 
phthisis  among  the  better  classes  at  Tien-tsin. 
especially  among  women." "^  Here,  of  course,  are 
the  classes  that  get  the  milk  and  the  meat.  It 
is  very  interesting  to  read  the  reports  of  medical 
men  regarding  phthisis  in  China,  and  the  differ- 
ent reasons  by  which  they  endeavor  to  explain 
its  rarity.  Mr.  Porter  Smith  says:  "  Supposing 
phthisis  to  be  rare,  it  cannot  be  attributed  to  the 
absence  of  a  special  tuberculiar  diathesis  among 
the  Chinese;  "  and  Dr.  Reid,  after  enumerating 
the  supposed  causes  of  phthisis,  says:  ''  If  con- 
sumption did  not  follow  as  a  consequence  of  all 
this,  we  should  have  a  result  different  from  vdiat 
has  been  observed  in  other  parts  of  the  world 
where  like  predisposing  causes  are  found,  .... 
or  that  some  other  conditions  exist  that  modify 

♦Dobell's  Reports. 


Distribution  of  Tuberculosis.  6i 

or  neutralize  them."  The  before-quoted  Dr. 
Jamison  says  that  bronchial  catarrh  is  exceed- 
ingly common  and  often  simulates  phthisis. 

Here,  then,  we  have  a  country  with  two  classes 
one  milk-drinkers  and  the  other  non-milk- 
drinkers — and  medical  authorities  have  not  been 
al^le  to  assign  an  acceptable  reason  for  the  preva- 
lence of  phthisis  in  one  class  and  not  in  the  other, 
where  the  commonly  received  predisposing 
causes  exist  to  the  greatest  extent. 

Let  us  now  direct  our  attention  to  regions 
where  cattle  abound,  but  not  as  inbred  dairy 
stock,  and  where,  consequently,  milk  is  not  an 
article  of  diet.  Such  is  South  A.merica.  "  In 
Colombia  the  practice  of  milking  cows  was  laid 
aside  owing  to  the  great  extent  of  the  farms  and 
other  circumstances.  In  a  few  generations,  M. 
Rollin  says,  the  natural  structure  of  parts,  and 
withal  the  natural  state  of  the  functions,  has  been 
restored.  The  secretion  of  milk  in  the  cows  of 
this  country  is  only  an  occasional  phenomenon 
and  contemporary  with  the  actual  presence  of  the 
calf.  If  the  calf  dies,  the  milk  ceases  to  flow."* 
Holden,t  in  his  interesting  book  on  this  country, 
says  that  butter  is  unknown,  milk  only  occasion- 
ally used  and  only  extracted  from  the  cows  when 

*  Prichard,  Nat.  Hist,  of  Man,  London,  1843,  P-  34- 
+  Holden,  New  Granada,  New  Yotk  ^^^ 


62  Distribution  of  Tuberculosis. 

they  have  their  calves  with  them,  and  ahvays 
boiled.  This  author  also  adds,  in  his  chapter  on 
diseases  in  this  country:  "  There  is  little  or  no 
consumption.  I  do  not  recollect  of  a  single  case." 
As  to  the  Argentine  Republic,  Consul  Baker,  of 
the  United  States,  writes  in  the  Western  Dairy 
Journal,  ''  It  may  seem  paradoxical,  yet  it  is  true, 
that,  while  the  Argentine  Republic  contains 
12,000,000  of  horned  cattle,  it  produces  neither 
butter  nor  cheese;  such  a  thing  as  a  dairy  farm 
is  unknown;  such  a  thing  as  butter-making,  in 
the  true  sense  of  the  word,  is  a  myth;  such  a  thing 
as  a  cheese  factory,  if  we  except  a  cheap  curd  pro- 
duced in  Goya,  has  never  been  attempted.  In 
this  immediate  neighborhood  you  may  or  may 
not  find  milk  enough  for  your  coffee,  but  else- 
where no  one,  with  rare  exceptions,  keeps  a  milch 
cow;  butter,  if  used  at  all,  has,  until  very  recently, 
been  brought  from  Italy;  of  late,  unsalted  butter, 
the  work  of  Spanish  Basques,  near  Buenos  Ayres, 

has  l}een  finding  its  way  to  market Not 

long  ago  I  visited  a  ranch  stocked  with  15.000 
cattle,  and  we  did  not  have  a  mouthful  of  butter 
for  our  bread,  while  our  coffee  was  seasoned  with 
condensed  milk  from  Illinois."  AVe  find,  from  the 
writings  of  Mantegazza  on  the  health  of  this 
country,  quoted  by  Hirsch,  that  there  has  been, 
within  the  last  fifty  or  sixty  years,  a  diffusion  of 


Distribution  of  Tuberculosis.  63 

phthisis  along  the  coast  of  this  repubHc,  princi- 
pally among  the  negroes  and  mulattoes;  but  in 
the  interior  and  mountainous  parts  there  is  an 
exemption.  Of  course,  in  the  case  of  phthisis 
along  the  coast,  unless  the  imported  cases  are 
separated  from  the  indigenous  cases,  the  value  of 
this  evidence  has  no  weight  in  our  argument.  It 
might  be  noticed  that  ithe  invasion  of  phthisis 
on  the  coast  coincides  very  nearly  with  the  inde- 
pendence of  the  country  and  the  accompanying 
admission  of  foreigners,  while  in  the  interior, 
where  the  natives  are  more  numerous,  immunitv 
from  the  disease  prevails. 

I  have  in  a  previous  paper  cited  the  facts  rela- 
ting to  Ecuador,  and  the  remarkable  result  that 
the  natives,  where  they  do  not  use  milk,  are  ex- 
empt from  pulmonary  tuberculosis.  I  have  also 
in  a  previous  paper  alluded  to  the  absence  of 
phthisis  in  Egypt,  where  the  indigenous  inhab- 
itants did  not  make  use  of  the  milk  of  inbred 
dairy  cattle.  The  conclusions  I  arrived  at  at  that 
time  were  derived  from  my  reading  of  the  ac- 
counts of  that  country  given  b}^  various  travelers; 
and  since  then  I  have  written  to  Dr.  J.  A.  S. 
Grant,  Bey,  who  has  favored  me  with  the  follow- 
ing communication,  dated  September  3,  1889: 
''  With  respect  to  Egypt,  we  are  almost  exempt 
from  tuberculosis  unless  among  the  black  people 


64  Distribution  of  Tuberculosis. 

and  foreigners.  The  Copts  and  Arabs  are  re- 
markably free  from  phthisis  puhnonalis.  I  think 
buffalo  milk  is  the  only  staple  of  that  kind  sup- 
plied to  the  villages,  but  I  knovr  that  in  the  large 
towns  there  are  European  cows."  This  shows 
plainl}^  that  the  natives  do  not  breed  dairy  cattle 
and  are  exempt  from  puhPionary  tuberculosis, 
vrhile  in  the  towns  it  is  probable  that  the  Euro- 
pean cows  mentioned  in  the  bey's  letter  supply 
the  milk  to  the  foreigners. 

Like  Egypt,  all  the  rest  of  northern  Africa 
seems  to  be  exempt  from  tuberculosis.  Thus  re- 
garding Morocco,  a  country  to  v  hich  I  have  not 
before  alluded  and  which  was  thoroughly  ex- 
plored by  Dr.  Rohlfs  in  1861,  wdio  adopted  the 
habits  and  manners  of  the  natives,  acting"  as  a 
physician  both  among  the  people  and  in  the 
army,  he  writes  in  his  book:  "  Diseases  of  the 
lungs  are  scarcely  known  in  Morocco,""^  and  in 
enumerating  the  prevailing"  diseases  he  omits 
pulmonary  consumption  or  phthisis  entirely  from 
the  Hst;  and  he  also  says:  ''the  animals  of  the 
Draa  oasis  are  fine  and  similar  to  those  in  Mo- 
rocco, such  as  the  horse,  ass,  mule,  and  goat; 
cattle  are  not  common.  The  sheep  in  the  Ter- 
nate  provinces  are  woolless."t  He  speaks  only 
of  sheep's  milk  as  used  for  food  in  the  country. 

*  Rohlfs,  Adventures  in  Morocco,  London,  1874,  p.  83. 
t  Ibid.^  p.  348. 


Distribution  of  Tuberculosis.  65 

Taking  a  square  of  ten  degrees  of  longitude 
and  latitude,  making  the  geographical  portions 
nearly  rdentical,  we  have  in  this  square  Morocco, 
Portugal,  and  Spain.  Now,  these  latter  countries 
were  mostly  in  the  possession  of  the  Moors  for 
centuries,  and  although  they  are  classed  among 
the  civilized  races,  there  are  many  remains  of 
Moorish  customs  and  culture  still  surviving. 
They  are  an  agricultural  people,  and  the  dairy 
business  is  one  of  the  agricultural  pursuits.* 
According  to  Brandt,  quoted  by  Hirsch,  con- 
sumption is  prevalent  in  this  country.  This 
condition  of  affairs  applies  also  to  Spain,  as  these 
two  countries  are  usually  classed  together.  Now, 
it  must  be  granted  that  the  geographical  differ- 
ences between  these  countries  and  Morocco  are 
not  sufficient  to  account  for  the  prevalence  of 
pulmonary  consumption  in  the  one  and  its  ab- 
sence in  the  other,  the  presence  of  dairy  cattle  in 
one  and  not  in  the  other  is  probably  the  most 
marked  and  significant  difference.  This  differ- 
ence will  be  found  everywhere  in  the  world  where 
cattle  are  bred  for  the  sole  purpose  of  producing 
milk  or  early  matured  beef. 

I  am  very  firm  in  my  conviction  that  cattle 
can  be  bred  in  such  a  manner  that  they  will  be 
— 4 

*  Oswald  Crawford,  Portugal,  Old  and  New,  New  York*,  p.  155. 


66  Distribution  of  Tuberculosis. 

neither  scrofulous,  nor  tuberculous,  and  in  these 
respects  not  dangerous  to  the  human  race.  After 
due  deliberation  and  serious  study,  both  as  a  phy- 
sician and  as  a  cattle  breeder,  I  am  firmly  of  the 
opinion  that  the  blessings  conferred  upon  us  by 
the  bovine  tribe  far  outweighs  the  burden  of  the 
disease  which  they  have  entailed  on  us.  When  I 
read  of  countries  that  have  no  tuberculous  food- 
producers,  and  consequently  enjoying  a  total  im- 
munity from  this  disease,  I  remember  at  the  same 
time  that  they  suffer  from  still  more  grievous 
afflictions,  both  from  the  lack  of  the  food  fur- 
nished us  and  from  the  presence  of  disease  in 
some  form  derived  from  their  ow^n  cattle.  If  it 
were  impossible  to  improve  our  own  domestic 
cattle  in  regard  to  their  own  and  our  health,  I 
should,  I  repeat,  be  in  favor  of  letting  the  matter 
rest  as  it  is.  Deeming  it,  however,  quite  possible 
to  breed  our  animals  without  any  scrofulous 
taint,  and,  in  lieu  of  the  burden  of  disease,  assume 
the  burden  of  a  heavier  financial  expense,  I  earn- 
estly urge  a  reform. 

The  foremost  cattle  breeders  have  aimed  at 
producing  an  artificial  animal,  capable,  when 
bred  for  beef,  of  early  maturity  and  early  fecun- 
dity; and,  when  bred  for  the  dairy,  all  other  con- 
siderations were  made  subsidiary  to  an  abundant 
flow  of  milk.     It  would  appear  to  these  men  ab- 


Distribution  of  Tuberculosis.  (^y 

ject  foolishness  to  breed  an  animal  for  strength, 
health,  and  robustness  with  a  smaller  yield  of 
milk.  They  would  not  deem  it  an  improvement 
to  breed  an  animal  that  did  not  mature  early, 
and  whose  dam  would  not  produce  a  calf  till  she 
was  three  years  old.  But  only  by  this  method 
can  we  stamp  out  tuberculosis  in  our  beef  and 
dairy  animals,  and  I  am  convinced  that  legislative 
action  will  be  necessary  to  keep  the  breeders  in 
this  line,  for  it  is  one  of  the  hardest  things  in  the 
world  to  upset  a  recognized  commercial  system. 
Thus  the  question  is  focused:  "  Are  we  willing 
to  pay  more  for  beef  and  dairy  products,  and 
throw  off  the  incumbrance  of  disease,  or  let  the 
matter  remain  as  it  is — an  abundant  supply  of 
cheap  milk  and  cheap  beef?  " 


[Reprinted  from  "  The  New  York  Medical  Journal,"  June  28,  i8qo.] 

CONSANGUINEOUS  BREEDING  IN  ITS 

RELATIONS  TO  SCROFULA  AND 

TUBERCULOSIS.* 

In  the  propagation  of  young,  the  union  of 
two  distinct  sexes  is  an  essential  requirement  for 
the  higher  order  of  animals,  and  Mr.  Herbert 
Spencer  accounts  for  the  formation  of  two  sexes 
by  the  assumption  that  thus  only  can  consan- 
guineous unions  be  avoided.  If  it  had  been  bet- 
ter that  animals  should  be  produced  from  one  in- 
dividual and  thus  continuing  to  represent  that 
individual  and  that  individual  alone,  man 
and  the  higher  orders  of  animals  would  have 
been  created  hermaphrodite  or  parthenoge- 
netic.  But  in  the  great  plan  of  nature  we 
see,  besides  the  different  sexes,  different 
groups  of  permanent  varieties  of  the  species, 
and  breeds  are  the  result  of  the  mingling  of 
these  varieties  in  different  proportions.  Thus, 
in  the  human  race,  to  avoid  the  repetition  of  a 
single   individual,   not   only   are   there   distinct 

•  Read  before  the  Society  of  Medical  Jurisprudence  and  State  Medicine, 
March  10,  iSgo. 

69 


yo  Scrofula  and  Tuberculosis. 

sexes,  but  also  distinct  groups  of  the  same  spe- 
cies capable  of  mixing  and  reproducing  their 
kind,  and  many  of  the  races  now  existing  are  un- 
doubtedly made  up  by  mixture  of  two  or  more  of 
the  permanent  varieties.  The  dominant  race  of 
to-day,  the  white  race,  shows  distinctly  that  they 
are  not  derived  exclusively  from  any  one  per- 
manent variety,  but  must  have  been  formed  by 
the  mingling  of  two  or  more  of  the  permanent 
varieties,  as  evidenced  by  the  existence  in  the 
sam.e  race  of  such  different  types  as  the  blonde 
and  the  brunette,  and  of  different  temperaments, 
and  the  commingling  of  all  these  types  in  every 
conceivable  gradation,  as  dark  hair  with  light 
eyes,  and  light  hair  with  dark  eyes,  red  hair,  and 
all  kinds  of  varieties  cropping  out  in  the  same 
family  of  children. 

It  seems  to  me  that  all  those  who  have  studied 
the  subject  of  consanguinity  have  sight  of  this 
tact — that  two  individuals  consanguineously  re- 
lated represent  not  only  the  immediate  parents, 
but  a  certain  mixture  of  the  permanent  varieties 
of  their  species.  Thus  some  of  the  domestic  ani- 
mals that  we  know  contain  only  two  permanent 
varieties  in  the  species,  and  it  is  from  a  mingling 
of  these  varieties  that  the  breeds  are  made;  and 
the  permanency  of  these  breeds  depends  on  the 
amount  of  mixture  of  these  varieties  in  each 


Scrofula  and  Tuberculosis.  71 

breed,  as  when  one  of  these  elements  is  bred  out 
or  attenuated,  then  the  breed  becomes  scrofu- 
lous, sterile,  and  in  every  way  deteriorated  by  the 
close  consanguinity  of  one  variety.     And  thus 
we  find  that  animals  more  prone  to  scrofula,  re- 
sulting from  consanguinity,  are  those  of  the  least 
number  of  distinct  groups  to  the  species;  hence, 
in  a  few  generations,  if  the  mingling  of  the  varie- 
ties has  not  been  equal,  one  of  them  is  bred  out 
or  attenuated  to  such  an  extent  as  to  be  almost 
entirely  lost.     Of  course  animals  that  produce 
many  young  at  one  gestation  will  show  this  de- 
teriorating process  sooner  than  a  uniparous  ani- 
mal, because  the  debilitating  effect  of  gestation 
must  be  greater.     Thus  the  pig,  a  muciparous 
animal  with  two  groups  to  the  species,  develops 
the  scrofulous  habit  more  readily  than  any  of  the 
other  domestic  animals.     Next  in  order  come 
the  bovine  tribe,  a  uniparious  race,  with  two 
groups  known  at  present,  with  a  probability  of 
other  groups  that  have  become  extinct.     These 
animals  develop  the  scrofulous  habit  from  in- 
and-in  breeding,  but  not  in  so  few  generations 
as  the  pig  does.     According  to  this  argument, 
the  development  of  the  scrofulous  habit  in  man 
from  close  interbreeding  would  be  remote,  be- 
cause there  have  been  many  permanent  varieties 
of  the  human  family;  but  there  are  in  the  human 


"^2  Scrofula  and  Tuberculosis. 

family  many  other  deteriorating  influences  at 
work;  alcoholism,  syphilis,  debauchery  of  all 
kinds  have  stamped  their  imipress  on  the  off- 
spring, which  is  characterized  sometimes  only  by 
the  scrofulous  habit  and  intensified  by  consan- 
guinity. 

Questions  relating  to  consanguinity  and  scrof- 
ulosis  have  received  an  immense  amount  of  atten- 
tion and  all  kinds  of  conclusions  have  been 
reached;  but,  from  the  fact  that  scrofula  is  so 
slow  sometimes  in  showing  its  results,  except  in 
the  pig,  in  breeds  that  have  resulted  from  the 
commingling  of  the  groups  of  one  species,  even 
when  the  scrofulous  habit  has  been  thus  devel- 
oped, the  positive  diseases  that  follov/  this  con- 
dition are  not  alw^ays  developed,  or  developed 
at  times  only  slowly,  and  so  remote  from  the 
original  primary  causes  that  these  causes  are  lost 
sight  of.  Tracing  up  the  course  of  some  of  our 
specific  contagious  fevers,  we  are  able  to  see  the 
connection  between  the  primary  cause  and  the 
specific,  and,  these  being  so  close  together,  we 
are  always  able  to  grasp  the  whole  train  of  cause 
and  effect.  In  scrofulosis,  effects  do  not  follow 
causes  in  the  same  number  of  cases  where  cir- 
cumstances tend  to  develop  the  cause,  as  in  the 
specific  fevers,  because  scrofula  is  always  a  con- 
genital condition  and  is  not  itself  a  disease,  but 


Scrofula  and  Tuberculosis.  73 

a'susceptibility  to  morbid  conditions  that  are  so 
uncertain  and  insidious  that   consequently  the 
study  of  this  condition  is  always  misleading  when 
small  groups  or  limited  areas  constitute  the  field 
of  observation.    It  is  only  in  large  masses  of  facts 
with   numbers   of   Hving   beings   whose   origin, 
pedigree,  modes  of  breeding,  and  all  other  con- 
comitant facts  are  taken  together,  that  we  can 
reach  a  clear  solution  of  the  connection  between 
consanguineous  unions  and  their  train    of  dis- 
eases.   Thus  I  have  ascertained,  taking  the  whole 
world  as  the  field  of  observation,  that  human 
tuberculosis   exists   only  in   those   communities 
closely  associated  with  the  inbred  bovine  species. 
This  observation  does  not,  of  course,  exclude  the 
now  acknowledged  fact  that  bacillary  phthisis 
can  be  conveyed  from  one  human  subject  to 
another  by  contagion,  because  this  is  a  part  of  the 
fact  that  the  original  contagion  was  derived  from 
the  bovine  species;  thus,  where  the  inbred  tuber- 
cular cattle  are  unknown,  bacillary  phthisis  is 
also  unknown. 

I  do  not  desire  to  discuss  any  of  the  questions 
relating  to  race  problems,  but,  from  several  years 
of  close  study  of  the  methods  of  cattle-breeding 
and  their  diseases,  and  of  their  intimate  relation- 
ship to  mankind,  I  am  convinced  that  the  bovine 
race  is  scrofulous,  the  result  of  close  consanguin- 


74  Scrofula  and  Tuberculosis. 

ity,  and  tubercular  from  their  scrofulous  habit,  and 
this  fact  is  almost  too  well  known  to  need  the 
addition  of  any  one's  testimony,  as  a  great  ma- 
jority of  those  who  have  studied  the  subject  are 
agreed  on  this  point.  But  I  am  thoroughly  con- 
vinced, as  I  have  said  before,  that  the  inbred 
bovines,  by  reason  of  their  scrofulous  habit  and 
consequent  susceptibility  to  tubercular  disease, 
convey  to  the  human  race  bacillary  phthisis;  that 
this  danger  can  be  avoided,  and,  to  point  out 
methods  of  protecting  the  human  race  from  this 
source  of  infection,  I  w^ould  adduce  the  following 
argument: 

As  I  stated  in  the  beginning  of  this  paper  that 
the  pig  was  more  prone  to  evil  results  from  con- 
sanguineous union  than  any  of  the  other  domestic 
animals,  and  that  these  evil  results  follow  more 
closely  the  primary  cause  and,  therefore,  can  be 
more  easily  traced,  and  the  fundamental  princi- 
ples of  the  argument  more  simply  and  clearly 
demonstrated,  I  will  commence  with  a  few  illus- 
trations, gleaned  from  the  best  authorities  on 
questions  of  breeding,  respecting  that  animal. 

This  species  can  be  divided  into  two  groups, 
or  permanent  varieties — namely,  the  Sus  indicus 
and  the  Siis  scrofa — and  all  the  different  breeds 
are  made  up  of  these  two  difTerent  groups  of  the 
pig  family.     So  distinct  are  these  two  varieties 


Scrofula  and  Tuberculosis.  75. 

that  Nathusius  (quoted  by  Darwin)  says  that  he 
can  trace  the  infusion  of  one-thirty-second  or 
one-sixty-fourth  part  of  the  blood  of  one  of  these 
groups  into  that  of  the  other,  in  the  bony  forma- 
tion. Darwin  himself  says:  "With  respect  to 
pigs  there  is  more  unanimity  among  breeders  on 
the  evil  effects  of  close  interbreeding  than  per- 
haps with  regard  to  any  other  large  animal.  Mr. 
Druce,  a  great  and  successful  breeder  of  the  im- 
proved Oxfordshires  (a  crossed  race),  writes: 
'  Without  a  change  of  boars  of  a  different  tribe, 
but  of  the  same  breed,  constitution  cannot  be 
preserved.'  Lord  Western  was  the  first  im- 
porter of  a  Neapolitan  boar  and  sow;  '  from  this 
pair  he  bred  in  and  in  until  the  breed  was  in 
danger  of  becoming  extinct,  a  sure  result  (as  Mr. 
Sidney  remarks)  of  in-and-in  breeding.'  "  Mr. 
Darv/in  further  relates  that  a  Mr.  Wright,  a  well- 
known  breeder,  bred  a  family  of  pigs  in-and-in 
for  seven  generations;  the  number  of  pigs  was 
reduced  at  each  gestation,  and  of  the  offspring 
thus  produced  many  were  idiotic,  without  sense 
even  to  suck,  and,  when  attempting  to  move 
could  not  walk  straight,  till  finally  one  sow  was 
the  sole  offspring.  She  was  the  handsomest  of 
the  entire  seven  generations,  but  would  not  be- 
come pregnant  by  her  sire,  while  to  a  stranger  in 
blood  she  bred  at  the  first  trial.     "  Nathusius 


^6  Scrofula  and  Tuberculosis. 

gives  an  analogous  and  even  more  striking  case. 
He  imported  from  England  a  pregnant  sow  of 
the  large  Yorkshire  breed,  and  bred  the  product 
closely  in-and-in  for  three  generations;  the  result 
was  unfavorable,  as  the  young  were  weak  in  con- 
stitution, with  impaired  fertility.  One  of  the 
latest  sows,  which  he  esteemed  a  good  animal, 
produced,  when  paired  with  her  own  uncle  (who 
V\^as  known  to  be  productive  with  sows  of  other 
breeds),  a  litter  of  six,  and  a  second  time  a  litter 
of  only  five  weak  young  pigs.  Then  he  paired 
this  sow  with  a  boar  of  a  small  black  breed, 
which  he  had  likewise  imported  from  England. 
This  boar,  when  matched  with  sows  of  his  own 
breed,  produced  from  seven  to  nine  young  pigs; 
now,  the  sow  of  the  large  breed,  which  was  so 
unproductive  when  paired  with  her  own  uncle, 
yielded  to  the  small  black  boar  in  the  first  litter 
twenty-one,  and  in  the  second  Htter  eighteen 
young  pigs,  so  that  in  one  year  she  produced 
thirty-nine  fine  young  animals.  Colonel  Le 
Conteur  Avrites  me  that  from  possessing  a  fine 
breed  of  pigs  he  bred  them  very  closely,  twice 
pairing  brothers  and  sisters,  but  nearly  all  the 
young  had  fits  and  died  suddenly."* 

All  the  above  is  taken  from  Darwin,  who,  of 


♦  Darwin,  Animals  and  Plants  under  Domestication,  Vol.   i,  p.  loi. 


Scrofula  and  Tuberculosis.  'jj 

course,  only  quotes  from  the  works  of  others; 
but  the  facts  as  stated  are  well  known,  and  no 
successful  breeder  to-day  practices  close  consan- 
guineous unions  in  breeding  his  pigs.  It  would 
be  very  easy  to  compute  the  possibility  of  breed- 
ing out  an  infusion  of  one  of  the  varieties  where 
it  existed  only  in  the  proportion  of  a  third  to  the 
other  varieties,  with  this  close  interbreeding,  and 
it  is  also  easy  to  understand  how  a  cross  with 
another  breed  or  another  family  of  the  same 
breed  would  change  the  combination  of  the 
minglings  of  the  two  varieties. 

That  pigs  are  scrofulous  from  this  close  union 
is  well  known.  The  word  scrofula  is  derived 
from  the  name  of  one  of  these  groups,  the  Sus 
scrofa,  and  the  name  undoubtedly  indicated  the 
well-known  fact  that  close  consanguineous 
unions  of  these  animals  produced  a  constitu- 
tional condition  resembling  in  all  respects,  at 
least  as  near  as  an  animal  can,  human  scrofulous 
diathesis;  and,  furthermore,  the  common  people 
have  noticed  this  resemblance  and  termed  scrof- 
ulosis  "  swine  evil."  The  reason  why  these  ani- 
mals show  the  evil  results  of  in-and-in  breeding 
more  plainly  and  quickly  than  some  other  of  the 
classes  of  domestic  animals,  arises  from  the  fact 
that  there  are  only  two  groups  of  the  species,  and 
hence  there  is  less  possibility  of  modification  than 


yS  Scrofula  and  Tuberculosis. 

in  the  species  with  a  larger  number  of  permanent 
varieties.  Thus,  I  beHeve  if  a  species  of  animal 
existed  that  was  unique — that  is,  with  no  varie- 
ties— consanguineous  breedings  would  be  pro- 
ductive of  more  early  evil  effects  than  it  is  even 
in  the  pig,  and  probably  some  of  the  races  that 
have  become  extinct  were  races  that  were  so 
situated  as  to  miake  it  impossible  to  receive  an 
infusion  of  blood  from  some  of  the  other  per- 
manent varieties  of  these  species. 

Now,  as  a  contrast,  to  the  pig,  let  us  take  the 
horse  and  the  sheep.  Neither  of  these  animals 
is  scrofulous,  and  in-and-in  breeding  can  be  car- 
ried on  with  them  without  the  same  apparent 
tendency  to  deterioration;  neither  are  these  ani- 
mals subject  to  tubercular  infection,  with  very 
rare  exceptions.  The  breeds  of  domestic  sheep 
are  made  up  from  eight  or  more  permanent  va- 
rieties; it  is  therefore  easy  to  see  how  many  ad- 
mixtures of  different  bloods  can  be  infused 
together  to  make  the  different  breeds.  There- 
fore the  possibility  of  working  out  all  the  com- 
binations by  consanguineous  unions  would  take 
a  great  length  of  time;  and  the  same  rule  applies 
to  the  horse  in  his  insusceptibility  to  scrofula  and 
tuberculosis;  but  there  are  many  other  conditions 
associated  with  the  horse  under  domicstication 
that,  of  course,  belong  to  the  domain  of  heredity. 


Scrofula  and  Tuberculosis.  79 

such  as  spavin,  ring-bone,  exhaustion  from  over- 
work and  severe  strain,  stomach  derangements, 
etc.,  and  these  make  the  in-and-in  breeding  of 
horses  somxctimes  unprofitable.  Still  consan- 
guineous unions  in  the  case  of  this  animal  are 
never  productive  of  scrofula  and  its  attendant 
train  of  disease. 

All  the  foregoing  facts,  deductions  and  sug- 
gestions will  help  us  in  our  study  of  the  main 
question.    That  question  is,  can  we  prevent  the 
development  of  scrofula  and  tuberculosis  in  the 
dairy  cow  and  thus  eliminate  this  disease  from 
the  human  family?    There  is  no  other  animal  in 
creation  that  is  so  closely  and  intimately  associ- 
ated with  some  communities  of  the  human  race 
as  the  domestic  cow.     Her  milk  is  one  of  the 
most  absolute  necessities  for  the  nursery  and  the 
table  in  every  household;  every  part  of  her  flesh 
and  the  large  viscereal  organs  are  consumed  as 
human  food;  her  blood  is  consumed  by  some 
communities.     All  civilized  races  of  the  present 
day  acknowledge  the  utility  of  vaccine  virus  for 
the  prevention  of  small-pox,  and  this  virus  is 
transmitted  through  the  system  of  her  calf  before 
it  can  serve  as  a  protective  virus  for  the  human 
system.     Her  hoofs  and  horns  are  transformed 
into  the  gelatin  which  constitutes  one  of  the  deli- 
cacies of  the  table  and  sick-room,  her  hair  enters 


8o  Scrofula  and  Tuberculosis. 

into  the  composition  of  the  plasters  on  our  walls, 
and  with  her  hide  we  cover  our  feet.  This  animal 
has  been  bred  to  a  two-fold  purpose — namely,  to 
furnish  us  with  milk  and  with  beef;  in  breeding 
the  dairy  cow^  every  other  point  has  been  lost 
sight  of  except  the  main  function  of  a  milk- 
producer.  The  well-known  scrofulous  forms  in 
animals  and  the  human  kind  are,  unfortunately, 
the  largest  milk-yielders.  Therefore,  in  some  of 
the  noted  milking  breeds  the  form  sought  after 
by  breeders  is  that  which  will  correspond  with 
the  delineation  of  the  characteristic  form  of 
scrofulosis  given  by  Miller,"^  as  follows:  "The 
complexion  is  fair,  and  frequently  beautiful,  as 
well  as  the  features;  the  form,  though  delicate,  is 
often  graceful;  the  skin  is  thin  and  of  fine  tex- 
ture ^  *  *  the  pupils  are  unusually  spacious; 
the  eyeballs  are  not  only  large  but  prominent; 
the  eyelashes  are  long  and  graceful."  Now  let  us 
contrast  this  description  of  human  scrofula  with 
Dr.  L.  H.  Twaddell's  description  of  a  noted  dairy 
cow.  "  The  Jersey  cow  is  of  medium  size;  her 
peculiar  deer-Hke  aspect  distinguishes  her 
"■''  *  "^  her  head  is  long  and  slender,  the  muzzle 
fine,  the  nose  is  black,  and  the  large,  dreamy 
eyes  encircled  with  a  black  band  *  *  *  the 
limbs  of  the  Jersey  are  very  slender  and  fine;  her 

*  Principles  of  Surgery,  p.  53. 


Scrofula  and  Tuberculosis.  ^i 

neck  is  slender  and  rather  long;  "  and  Colonel 
George  E.  Waring,  Jr.,  says  he  knows  of  no  fault 
in  the  milking  cow  greater  than  a  thick  skin. 
Thus  we  have  in  the  scrofulous  human  subject  a 
beautiful  form,  a  thin  skin,  large  eyes,  and  the 
same  characteristics  as  those  found  in  the  best 
milking  form  of  the  dairy  cow.     Scrofulous  fe- 
males in  the  human  race  usually  secrete  an  abun- 
dance of  mjlk,  although  they  are  not  deemed  the 
best  nurses.     Even  Donne  alludes  to  this  fact 
and  cites  in  his  work  on  mothers  and  infants  the 
case  of  a  nurse  that  suckled  the  children  of  one 
of  the   most  noted   Paris  physicians,   and  was 
recommended  by  him  to  other  noted  famiUes, 
who,   when  examined  by  Donne  himself,  was 
found  to  be  in  a  scrofulous  condition.   Of  course, 
she  must  have  given  an  abundance  of  milk  to  be 
thus  recommended.    I  know,  too,  from  my  own 
experience,  that  scrofulous  females,  as  a  rule, 
secrete  a  larger  quantity  of  milk  than  healthier 
ones.     Although  the  scrofulous  female  with  her 
abundance  of  milk  would  not  be  recommended 
as  a  wet-nurse,  the  beautiful  scrofulous  dairy  cow 
is  never  declared  contraband. 

Let  us  now  examine  the  pedigree  and  breed- 
ing of  the  dairy  cow  and  see  why  this  animal  is 
scrofulous.     The  domestic  breeds  of  the  bovine 
tribe  are  made  up  from  two  permanent  varieties 
6 


82  Scrofula  and  Tuberculosis. 

of  the  species — namely,  the  Bos  longifrons  and 
Bos  primigeniiis ;  these  two  varieties  are  dis- 
tinctly identified,  one  as  the  large,  the  other  as 
the  smaller  form,  and  the  most  noted  dairy 
breeds  belong  to  the  smaller  with  very  little  of 
the  larger  breed  intermingled,  while  the  beef 
breeds  belong  to  the  larger  form  with  more  or 
less  infusion  of  the  smaller  to  make  the  distinc- 
tive breeds.  Let  us  take  one  of  the  most  noted 
dairy  breeds  we  have — the  Jerseys.  These  ani- 
mals have  been  bred  on  the  Channel  Islands  for 
several  generations,  without  ever  having  received 
a  cross  from  other  breeds,  and  they  were  the 
only  breed  on  the  island  of  Jersey.  These  ani- 
mals have  now  been  distributed  by  exportation 
among  breeders  in  various  parts  of  the  world, 
but  the  noted  herds  are  still  inbred  in  the  closest 
possible  manner. 

I  have  several  tabulated  pedigrees  of  Ameri- 
can-bred Jerseys,  and  will  cite  that  of  '*  Iduna." 
Through  six  generations  the  male  parent,  "  St. 
Helier,"  himself  an  intensely  inbred  bull,  has 
been  the  sire  twenty-five  times  in  her  genealogy 
— that  is,  impregnating  his  own  female  progeny 
through  twenty-five  lines  in  descent.  Animals 
produced  by  this  method  are  truly  delicate  and 
beautiful,  and  usually  good  milkers,  and  in  other 
points  fulfill  Miller's  description  of  the  human 


Scrofula  and  Tuberculosis.  83 

scrofulous  female.  Now,  scrofula  is  not  always 
tuberculosis,  but  I  believe  that  scrofula  precedes 
tubercular  infection.  In  this  connection  the  fol- 
lowing quotation  from  Hazard's  book  on  the 
Jersey,  Alderney,  and  Guernsey  cow  may  be  of 
interest:  "  Accordingly  some  good  milkers,  and 
particularly  old  cows  in  which  vital  activity  is 
constantly  decreasing  and  systematic  reaction 
becoming  progressively  more  and  more  difficult 
acquire  a  sickly  appearance;  the  defective  lymph 
is  deposited  in  the  form  of  tubercular  matter  so 
constantly  found  in  the  chest  of  old  cows,  the 
animals  become  phthisical,  the  organs  of  pro- 
creation become  unhealthy;  Vv^ith  m^ore  or  less 
constant  irritation  of  the  ovaries,  the  cow  be- 
comes barren.  With  this  irritation  there  is  a 
periodic  check  to  the  secretion  of  milk;  neverthe- 
less, a  very  considerable  flow  still  continues." 

There  is  little  need  for  me  to  add  that  this  milk 
sometimes  finds  its  way  to  the  nursery  of  a 
scrofulous  infant.  Now,  no  one  denies  that  these 
intensely  inbred  Jerseys  are  notoriously  tubercu- 
lar; they  are  nearly  all  scrofulous,  and  it  is  notori- 
ous that  this  breed  is  subjected  to  the  most  in- 
tense consanguinity;  and  Walley,  the  well-known 
v/riter  on  bovine  diseases,  says  in  his  book,  The 
Four  Bovine  Scourges:  "  The  breeds  of  animals 
that  in  my  experience  are  most  subject  to  tuber- 


84  Scrofula  and  Tuberculosis. 

cle  are  Alderneys,  Guernseys  (the  latter  in  much 
less  degree  than  the  former),  and  short-horns 
among  home  cattle,  and  among  foreign  cattle  the 
Danish."  Now,  we  know  all  these  breeds  enu- 
merated by  Walley  belong  to  the  most  closely 
inbred  dairy  and  beef  stock;  among  beef  cattle 
the  short-horns  are  the  most  intensely  inbred. 
As  a  rule,  these  beef  cattle  do  not  show  the  same 
distinctive  processes  of  the  tubercular  infection 
because  they  are  not  submitted  to  the  drain  of 
continual  lactation  as  are  the  dairy  breeds,  and, 
moreover,  are  well  fed  and  cared  for,  and 
butchered  when  they  are  between  three  and  four 
years  of  age;  hence  they  only  show  their  true 
condition  when  opened  by  the  butcher.  Further- 
more, to  show  that  this  scrofulous  and  tubercular 
condition  is  the  direct  result  of  consanguineous 
breeding,  we  will  take  a  breed  of  cattle  that  en- 
joys an  immunity  from  tuberculosis.  Walley,  the 
author  above  quoted,  says:  ''  The  polled  Aber- 
deenshires  seem  to  be  particularly  exempt."  Mr. 
Clement  Stephens,  chief  veterinary  inspector  for 
Northumberland,  states:  "  There  is  another  and 
more  valuable  advantage  these  cattle  possess — 
namely,  their  remarkable  freedom  from  tubercu- 
lar diseases.  Of  course  I  cannot  assert  that  it  has 
never  been  in  this  breed  of  cattle  (the  Aberdeen), 
but  this  I  can  say:    That,  although  I  have  had 


Scrofula  and  Tuberculosis.  85 

special  opportunities  for  research,  and  have  ex- 
amined great  numbers  of  cattle,  both  alive  and 
post  mortem,  I  have  never  yet  seen  a  trace  of  it 
in  this  breed."     Now,  these  cattle  are  not  of  an 
inbred  breed.    The  rigorous  climate  of  their  na- 
tive land  and  the  lack  of  housing  they  receive 
make  it  impossible  for  the  thin-skinned  inbred 
animal  to  exist  under  these  circumstances.    The 
following  is  quoted  from  the  Breeder's  Gazette 
with  reference  to  these  animals:    "  The  necessity 
of  keeping  a  house  over  his  head  has  prevented 
the  Aberdeenshire  breeder  from  following  the 
caprice  of  fashion;  the  blue-bloodqd  breed  for 
which  there  used  to  be  a  kindness  in  som.e  direc- 
tions  is  dreaded  beyond  everything;   the  very 
blueness  of  his  blood  makes  him  dangerous." 
From  the  same  source  I  quote  the  following  from 
a  correspondent  who  had  seen  these  cattle  and 
examined  their  thick  coating  of  hair  and  protect- 
ing skin;  and  comparing  them  with  the  short- 
horns, he  says:    "  But  I  now  firmly  beUeve  that 
every  one  of  those  animals  that  have  that  pecu- 
liar soft  handle  (feehng  of  the  skin)  that  I  was 
taught  by  my  brother  in  the  short-horn  world  to 
so  much  admire,  is  tuberculosis  in  one  or  other  of 
its  stages.     Up  to  the  time  that  an  animal  is  in 
the  last  stages  of  this  fell  disease  I  feel  its  hand- 
ling would  delight  many  of  the  best  short-horn 


86  Scrofula  and  Tuberculosis. 

judges.  We  have  bred  too  many  of  the  short- 
horns to  death."  The  great  breeder  of  the  polled 
Angus  and  the  great  authority  on  the  breed,  Mr. 
William  McCombie,  writes  thus  in  his  work  on 
Cattle  and  Cattle-breeding:  ''  To  continue  for 
any  length  of  time  to  breed  in-and-in  is  not  only 
against  my  experience,  but  I  believe  against  na- 
ture." I  have  also  searched  through  the  records 
of  this  breed  and  works  relating  to  it,  and  I  find 
none  of  them  giving  evidence  of  close  inbreeding. 
We  have  thus  the  two-ends  of  the  cattle-breeding 
question — one,  a  small,  intensely  inbred  and 
pampered  breed,  the  predominating  dairy  cow, 
a  true  scrofulous  animxal  and  numerously  affected 
by  tubercle;  the  other,  a  large,  hardy  cross-bred 
animal,  with  all  evidence  pointing  to  a  total  im- 
munity from  tuberculosis. 

Now,  I  have  seen  it  stated  man)^  times  that 
cattle  that  are  tuberculous  become  infected  from 
their  attendants  spitting  and  coughing  around 
the  stable.  If  this  were  at  all  an  aetiological 
factor,  we  should  find  no  breed  of  domestic  cattle 
exempt,  because  they  are  exposed  to  the  same  or 
nearly  the  same  class  of  associates  with  about  the 
same  degree  of  intimacy,  and  it  w^ould  be  very 
strange  if  one  man  to  ten  or  twenty  cows,  even  if 
he  were  phthisical,  should  be  able  to  infect  lo  or 


Scrofula  and  Tuberculosis.  87 

15  per  cent,  of  them  by  his  coughing  and  spitting, 
and  they  not  affect  him  while  he  is  drinking  their 
milk,  eating  their  flesh,  and  inhaling  their  breath. 
This  is  really  not  a  part  of  the  subject  under  dis- 
cussion; I  simply  introduce  it  here  while  discuss- 
ing these  two  breeds — the  tubercular  and  non- 
tubercular. 

I  think  there  can  be  no  doubt  whatever  that 
the  in-and-in  breeding  of  animals,  with  two  or 
three  permanent  varieties  only  to  the  species, 
does  produce  a  constitutional  weakness,  to  say 
the  least,  that  is  not  capable  of  resisting  bacillary 
tubercular  infection.  Tuberculosis  itself  is  rarely 
an  inherited  disease  in  the  bovine  tribe,  where 
this  disease  is  indigenous.  I  have  myself  exam- 
ined many  foetal  calves,  v/hose  mothers  were 
dead  from  acute  miliary  tuberculosis,  without 
ever  finding  the  gross  evidences  of  tubercular  in- 
fection; so  I  think  it  safe  to  say  that  the  rule  is 
that  the  disease  is  not  transmitted  by  inheritance, 
and  consequently  the  best  way  to  eliminate  a  dis- 
ease of  this  kind,  which  we  know  must  be  pre- 
ceded by  a  hereditary  constitutional  dyscrasia,  is 
to  breed  animals,  as  we  surely  can  do  with  our 
domestic  cow,  so  that  they  will  not  inherit  this 
scrofulous  habit. 

Of  course,  as  I  have  said  before,  these  two 


88  Scrofula  and  Tuberculosis. 

questions  of  consanguinity  and  scrofulosis  are 
difficult  to  stud}^  and  cannot  receive  their  true 
interpretation  from  any  few  isolated  cases  or 
small  groups  of  facts,  and  the  only  positive  deter- 
mination that  we  can  arrive  at  is  derived  from 
the  study  of  all  the  dairy  breeds.  In  them  we 
see  that  those  which  are  habitually  inbred  are 
scrofulous,  as  a  rule.  I  am  aware  that  almost  any 
one  can  adduce  simple  isolated  cases  showing 
that  an  inbred  animal  is  not  scrofulous  or  tuber- 
cular; but  when  the  facts  stands  this  way,  that 
when  all  the  scrofulous  and  tubercular  animals 
occur  among  the  inbred  varieties,  and  not  at  all 
among  those  that  are  not  inbred,  the  deduction 
to  be  drawn  is  obvious;  and  it  is  just  this  com- 
bination of  facts  that  makes  the  study  of  consan- 
guinity, scrofulosis,  and  tuberculosis  so  elusive. 
All  the  inbred  anim.als  are  not  scrofulosed,  and  all 
those  that  are  scrofulosed  are  not  tubercular;  and 
thus,  when  we  take  the  one  breed  that  is  notori- 
ously tubercular,  v/e  find  the  facts  pro  and  con,  as 
to  the  transmission  of  scrofulosis  and  the  invasion 
of  tuberculosis  are  of  equal  weight,  or,  if  any- 
thing, the  preponderance  of  evidence  would  be 
against  the  deteriorating  influence  of  consangu- 
inity; but  when  we  have  the  breed  that  is  exempt 
from  these  conditions,  and  observe  that  the  only 


Scrofula  and  Tuberculosis.  89 

difference  is  that  it  is  not  inbred,  then  we  account 
for  the  presence  of  less  or  more  tuberculosis  by 
the  disturbing  influence  of  consanguinity.  And 
so  with  the  study  of  tuberculosis  beyond  these 
questions  of  breeding.  We  find,  to  all  intents 
and  purposes,  people  surrounded  by  the  same  in- 
fluences and  exposed  to  the  same  degree  of  con- 
tagion and  infection  and  only  a  small  percentage 
acquire  the  disease.  We  have  no  doubt  about 
many  other  of  the  contagious  and  infectious  dis- 
eases, because  effect  and  cause  can  be  grasped  at 
one  time,  and  a  majority  of  persons  subjected  to 
the  same  exposure  in  the  same  circumstances  be- 
come infected.  And,  so,  then,  we  have  to  study 
this  disease — tuberculosis —  in  the  same  manner 
in  which  we  have  to  study  consanguinity — that 
is,  by  taking  whole  communities  or  nations,  as  it 
were,  and  if  we  find  in  one  country  immunity 
from  tuberculosis  in  the  human  race  and  no 
tubercular  cattle  associated  with  it,  and  in  an- 
other community,  notoriously  tubercular,  drink- 
ing milk  and  eating  meat  from  domestic  inbred 
animals,  then  we  have  the  large  aggregation  of 
fact  that  points  to  but  one  solution. 

Now,  there  can  be  no  doubt  in  the  minds  of 
intelligent  men  as  to  the  methods  necessary  to 
render  the  dairy  and  beef  products  safer  for  hu- 


go  Scrofula  and  Tuberculosis.  i 

man  food.  The  only  conflicting  element  to  what 
is  an  obvious  and  necessary  reform  would  be  that 
inexorable  law  of  compensation.  The  present 
methods  of  breeding  our  best  milk  and  beef  pro- 
ducers have  undoubtedly  lowered  the  price  of 
both  these  commodities,  and  with  this  lowering 
of  price  we  have  entailed  on  us  the  tax  of  disease. 
If,  then,  wx  wish  to  avoid  this  burden  and  breed 
our  milk  and  beef  animals  with  health  as  the  ulti- 
mate aim,  milk,  at  least,  will  be  a  far  dearer  com- 
modity than  it  is  at  the  present  time,  and  so  the 
question  will  be  narrowed  down  to  the  simple 
one  whether  we  shall  pay  eight  or  twenty  cents 
a  quart  for  milk.  I  am  only  aware  that  it  is  a  very 
diflQcult  matter  to  make  a  reform  in  the  methods 
of  cattle  breeding  that  have  been  carried  on  for 
so  many  generations,  and  done  very  often  by  men 
who  imagined  that  they  were  conferring  great 
benefits  on  the  human  race.  It  will  only  be  by 
constant  agitation,  and  by  a  constant  arraying  of 
facts,  as  I  have  suggested,  from  large  areas  and 
long  periods,  without  ever  allowing  this  import- 
ant question  to  be  narrowed  down  to  individual 
or  isolated  cases,  as  such  comparisons  of  a  limited 
number  of  facts  have  always  led  to  hasty,  con- 
fused, and  unsatisfactory  conclusions  when  ap- 
plied to  such  questions  as  those  of  consanguinity, 
scrofulosis,  and  tuberculosis. 


Scrofula  and  Tuberculosis.  91 

If  a  sweeping  reform  is  ever  made,  as  I  am 
convinced  it  should  be,  it  will  only  be  effected 
through  legislative  action,  for  I  am  convinced 
from  my  experience  that  our  lives  are  not  long- 
enough  to  turn  some  of  the  cattle  breeders  from 
the  error  of  improving,  as  they  deem  it,  our  dairy 
cows  and  some  of  the  beef  breeds  of  cattle. 


[Reprinted  from  "  The  New  York  Medical  Journal,"  December  20,  i8go.] 

THE  MIMICRY  OF  ANIMAL  TUBERCU- 
LOSIS IN  VEGETABLE  FORMS.* 

At  one  time  I  become  deeply  interested  in 
reading  the  travels  of  Livingstone  and  other 
brave  and  noted  explorers  of  Africa,  and,  while 
my  mind  was  full  of  the  wonders  and  mysteries 
of  the  Dark  Continent,  I  met  a  gentleman  who 
informed  me  that  he  had  resided  many  years  in 
Africa.  I  tried  to  obtain  from  him  information 
which  I  had  been  in  search  of.  I  spoke  of  the 
geographical  problems  to  be  solved  and  the  diffi- 
culties to  be  surmounted  in  civilizing  that  enor- 
mous continent,  and  the  whole  burden  of  his 
comments  was  that  Africa  was  a  great  country 
and  would  be  easily  civilized  and  all  obstacles 
overcome  if  it  was  only  properly  drained.  Now, 
this  man's  residence  in  Africa  had  been  confined 
to  the  west  coast,  where  the  notorious  swampy 
and  malarious  districts  lie,  and,  because  he  had 
not  traveled  farther  or  interested  himself  in  the 
travels  of  others,  he  imagined  that  all  Africa  was 

♦  Read  before  the  New  York  State  Medical  Association  at    its  Seventh 
Annual  Meeting. 

93 


94       Mimicry  of  Animal  Tuberculosis. 

like  that  portion  of  the  country  which  he  did 
know  would  be  the  better  for  draining. 

We  should  all  naturally  be  surprised  at  the  nar- 
nowness  of  this  man's  views,  who  imagined  that 
an  immense  continent  with  snow^-capped  moun- 
tains and  rainless  deserts  of  vast  extent  could  be 
judged  from  the  narrow^  limits  of  a  malarious 
swamp,  where  he  had  resided  for  a  few  years;  but, 
on  reflection,  the  idea  could  not  but  occur  to  me 
that  we  medical  men,  in  our  studies  of  the  Dark 
Continent  of  disease,  were  often  as  narrow  in  our 
views  as  this  man  was  in  his  views  of  Africa.  For 
instance,  a  very  few  years  ago  Koch  discovered  in 
a  tubercle  numerous  bacilli,  and  straightway  w^e 
fancy  that  the  tubercle  would  be  harmless  if  it 
were  only  drained  of  its  bacillus,  and  we  put  our- 
selves to  work  with  hot  air,  rectal  injections, 
medicated  inhalations,  etc.,  imagining  all  the 
time  that  we  could  subdue  this  terrible  and  mys- 
terious disease  and  settle  all  the  difficult  questions 
of  pathology  connected  therewith  by  simply 
eliminating  from  the  economy  the  bacillus  of 
Koch.  The  bacterial  region  is  emphatically  now 
our  place  of  residence;  we  w^ade  through  the 
swamps  of  pus,  blood,  and  morbid  tissues,  push- 
ing aside  all  other  forms  and  vital  processes,  after 
the  beckoning  specter  of  a  bacillus,  and,  when  we 
find  it,  flatter  ourselves  that  we  have  reached  the 


Mimicry  of  Animal  Tuberculosts.       95 

goal  and  discovered  all  that  is  necessary  to  con- 
quer a  disease  associated  with  this  small  organ- 
ism. We  hardly  inquire  how  it  gained  its  posi- 
tion, w^hat  its  functions  are  other  than  what  we 
imagine  as  being  concerned  in  the  causation  of 
disease,  but  accept  it  as  the  spirit  and  soul  and 
prime  factor  in  the  cause  of  pulmonary  tubercu- 
losis. Happily,  the  tendency  now  is  to  break  be- 
yond the  bounds  of  this  narrow  bigotry;  hence  I 
think  that  a  study  of  some  of  the  vegetable  forms 
that  closely  mimic  animal  tuberculosis  will  help 
us  in  our  march  beyond  the  narrow  swamp 
through  which  we  are  still  struggling. 

One  of  the  vegetable  diseases  which  mimic 
very  closely  tuberculous  animal  processes  is  seen 
in  the  nut-gall.  The  nut-galls  are  truly  tubercu- 
lar processes  affecting  the  breathing  apparatus 
(leaves)  and  the  nutritive  channels  (roots)  of 
plants.  These  galls  are  among  the  most  puzzling 
of  natural  phenomena.  It  is  actually  known  that 
the  Cynips,  or  gall-fly,  a  small  insect  of  the  hy- 
menopterous  order,  punctures  the  leaf  of  a  plant 
or  tree,  and  there  deposits  an  egg,  injecting  at 
the  same  time  a  very  minute  drop — the  animal 
itself  is  only  one-tenth  of  an  inch  in  length — of 
what  is  described  by  entomologists  as  a  poison, 
but  which  is,  beyond  doubt,  a  digestive  ferment. 
This  fluid,  injected  by  the  insect  into  the  cavity 


\^6       Mimicry  of  Animal  Tuberculosis. 

that  holds  the  ^gg,  affects  the  nutritive  process  of 
the  plant  in  such  a  preponderating  manner  that 
it  allows  the  tgg  to  rest  in  the  cavity  without  the 
irritating  results  of  the  intrusion  of  a  foreign 
body,  and  the  extraordinary  nutrition  caused  by 
the  ferment  goes  on  to  form  the  tubercular  mass 
knov\^n  as  a  gall. 

Far  more  interesting  and  more  closely  analo- 
gous to  animal  tuberculosis  is  the  disease  attack- 
ing the  grape-vine  caused  by  the  insect  called 
Phylloxera.  Can  anything  in  plant-life  more 
closely  resemble  a  human  tubercular  lung  than  a 
leaf  of  a  grape-vine  with  the  galls  of  Phylloxera  f 
''  In  August,  1835,  Luiz  de  Andrade  Corvo  pre- 
sented a  paper  to  the  ^Academy  of  Sciences  in 
which  he  asserted  that  the  vine  disease  ascribed 
to  Phylloxera  vastatrix  w^as  really  due  to  a  bacil- 
lus, or  rather,  according  to  his  description,  to  a 
bacterium,  w^hich  is  always  found  in  the  tubercles 
of  the  radicles  and  in  the  tissues  of  the  vine  which 
are  affected  by  this  disease,  termed  by  him  tuber- 
culosis. They  are  also  found  in  the  body  of  the 
insect,  which  thus  becomes  simply  the  agent  of 
contagion."  * 

Now,  has  not  this  author  narrowed  his  views 
down  to  the  bigotry  of  bacilli-worship?     The 

*  Microbes,  Ferments,  and  Molds.     By  E   L.  Trore-sart.     D.  Applctoa 
&  Co.,  New  York,  1S86. 


Mimicry  of  Animal  Tuberculosis.       97 

presence  of  a  bacterium  in  this  disease  of  plant- 
life  is  only  one  of  many  phases  of  a  morbid  pro- 
cess.   The  bacillus  he  discovers  here  is  merely  the 
nutritive  ferment  deposited  by  all  gall  insects, 
and   often,   as  we   have   already   said,   called   a 
poison.    The  Phylloxera  vastatrix,  like  the  Cynips 
querciis,  wounds  the  leaf,  deposits  its  egg  in  the 
wound,  and  besides,  injects  the  bacterium  which 
is  the  nutritive  ferment  that  produces  the  gall 
v/hich  characterizes  the  disease.     The  following 
sketch  of  the  natural  history  of  the  Phylloxera  is 
taken  from  John  Henry  Comstock's  Introduction 
to  Entomology:     "  The  grape  Phylloxera  hiber- 
nates in  the  roots  of  the  grape  mostly  as  a  young 
larva  of  the  first  or  sedentary,  agam^ic,  wingless 
form.     With  the  renewal  of  vine  growth  in  the 
spring  this  larva  moults  rapidly  increases  in  size, 
and  soon  commences  laying  eggs.    These  in  due 
time  give  birth  to  young,  v/hich  soon  become 
agamic,  egg-laying  mothers  like  the  first,  and, 
like  them,  always  remain  wingless.     Five  or  six 
generations  of  these  parthenogenetic,  egg-bear- 
ing, wingless  mothers  follow  each  other,  when 
(about  the  middle  of  June  in  the  latitude  of  St. 
Louis)  some  of  the  individuals  begin  to  acquire 
v/ings.    Thus  is  produced  the  second  or  migrat- 
ing agamic,  winged  form.    These  issue  from  the 
ground  while  yet  in  the  pupa  state;  as  soon  as 
7 


gS       Mimicry  of  Animal  Tuberculosis. 

they  have  acquired  wings  they  rise  in  the  air  and 
spread  to  new  vineyards,  vrhere  they  lay  their 
eggs  usually  in  the  dovrn  of  the  under  sides  of  the 
leaves.  Each  individual  of  this  generation  lays 
from  three  to  five,  and  some  as  many  as  eight 
eggs.  These  eggs  are  of  two  sizes;  the  smaller, 
which  produce  males,  are  about  three-fourths  of 
the  size  of  the  larger,  which  produce  females. 
From  these  eggs  are  hatched  in  the  course  of  a 
fortnight  the  third  or  wingless  sexual  form.  Tc 
is  a  very  remarkable  fact  that  this  form  emerges 
from  the  egg  not  as  larva,  but  as  fully  developed 
individuals.  These  sexual  individuals  are  born 
for  no  other  purpose  than  the  production  of  their 
kind,  and  are  without  means  of  flight  or  taking 
food.  After  pairing,  the  body  of  the  female  en- 
larges somewhat,  and  she  is  soon  delivered  of  a 
solitary  egg.  The  impregnated  egg  gives  birth 
to  a  young  louse,  which  develops  into  the  first 
form,  and  thus  recommences  the  cycle  of 
changes.  It  has  been  discovered  that  sometimes 
the  first  form  during  the  latter  part  of  the  season 
lays  a  few  eggs,  which  are  of  two  sizes  like  those 
of  the  second  form,  and  also  produces  males  and 
females,  which  are  precisely  like  those  born  of 
the  winged  form,  and,  like  them,  produce  the 
solitary  im.pregnated  egg.  Thus  the  fact  is  es- 
tabUshed  that  even  the  winged  form  is  not  essen- 


Mimicry  of  Animal  Tuberculosis.       99 

tial  to  the  perpetuation  of  the  species.  Occasion- 
ally individuals  abandon  their  normal  under- 
ground habit  and  form  galls  upon  the  leaves  of 
certain  varieties  of  grape-vine.  Owing  to  the 
great  injury  this  species  has  done  to  the  vine- 
yards of  France,  hundreds  of  memoirs  have  been 
published  regarding  it.  But  as  yet  no  satisfac- 
tory means  of  destroying  it  has  been  discovered. 
The  difficulty  hes  in  the  fact  that  the  insecticide 
m.ust  be  one  that  can  penetrate  the  ground  to  the 
depth  of  three  or  four  feet,  reaching  all  the 
fibrous  roots  infested  by  the  insect.  It  must  be 
a  substance  that  can  be  cheaply  applied  on  a  large 
scale  and  that  v/ill  kill  the  insect  without  injury 
to  the  vine.  Where  the  vineyards  are  so  situated 
that  they  can  be  submerged  with  water  for  a 
period  of  at  least  forty  days  during  winter,  the 
insect  can  be  drowned.  It  is  found  that  vines 
growing  in  very  sandy  soils  resist  the  attacks  of 
the  grape  Phylloxera.  This  is  supposed  to  be  due 
to  the  difficulty  experienced  by  the  insect  in  find- 
ing passages  through  such  soil." 

Here  we  have  the  whole  natural  history  of  a 
bacillary  tubercular  disease  in  plants.  Notwith- 
standing the  fact  that  every  phase  of  its  life  his- 
tory is  well  understood  and  the  diseased  parts  can 
be  seen  and  handled,  yet  its  treatment  is  futile. 
This  teaches  us  the  narrowness  of  our  study  of 


loo     Mimicry  of  Animal  Tuberculosis. 

human  tuberculosis  when  we  imagine  that  Koch's 
discovery  of  the  bacillus  placed  us  in  a  position 
to  treat  this  complicated  disease.  We  do  not 
know  the  m.anner  in  which  the  bacillus  gains  the 
position  it  occupies  in  the  tubercular  mass,  or 
why  it  sometimes  attacks  the  lungs,  and  some- 
times the  glands,  and  sometimes  the  bones.  Is 
it  conveyed  to  its  position  by  a  host?  Nothing 
we  as  yet  knov/  indicates  this  supposition  except 
the  analogy  of  vegetable  parasites.  It  is  not 
found  in  the  blood  or  in  the  mxuscular  juices.  The 
Dresent  exclusive  devotion  to  the  observation  of 
bacteria  would  almost  preclude  the  detection  of 
host  if  one  did  exist.  Crookshank,  in  an  appen- 
dix to  his  work  on  Bacteriology,  says:  "When 
examining  blood,  the  bacteriologist  must  be  pre- 
pared to  meet  the  minute  organisms,  which  at 
the  first  glance  under  moderate  amplification 
may  be  mistaken  for  vibrionic  or  spiral  forms  of 
bacteria.  The  organisms  referred  to  belong  not  to 
the  vegetable  but  to  the  animal  kingdom.  They 
may  occur  associated  with  disease;  but  they  ap- 
pear to  be  more  commonly  found  in  the  blood  of 
apparently  perfectly  healthy  animals."  Thus  the 
fact  is  stated  by  good  authority  that  parasitic 
anim.als  do  exist  in  the  blood. 

This  is  not  the  only  parasite  to  illustrate  the 
mimicry  of  animal  and  vegetable  morbid  forms. 


Mimicry  of  Animal  Tuberculosis,     ioi 

There  are  myriads  of  parasites,  and  parasites  on 
parasites,  in  the  descending  scale  to  the  minutest 
forms.  Thus  all  vital  activity  is  kept  in  unison; 
nothing  is  allowed  to  die;  one  Hving  organism 
ceases  that  others  may  continue,  and  the  others 
in  turn  are  dissolved  to  continue  other  phases  of 
vital  activity.  The  little  germ  that  robs  man  of 
his  vitahty  undoubtedly  conveys  that  vitality  to 
some  other  living  organism,  thus  forming  a  link 
in  the  endless  chain  of  organisms  in  action. 

Another  form  of  change  not  parasitic  is  sug- 
gestively analogous  to  the  bacillary  tubercular 
phenomena.  The  yeast  plant  is  a  germ,  and  un- 
doubtedly Pasteur's  noted  researches  on  the  life 
history  of  this  plant  formicd  the  starting  point  for 
the  universal  study  of  bacteriology  to-day.  No 
thinking  man  could  have  followed  his  reasonings, 
conclusions,  and  deductions  without  concluding 
that  all  febrile  conditions  at  least  were  the  result 
of  the  growth  of  germ-life,  producing  ptomaines, 
extractives,  etc.  There  are  many  phases  of  alco- 
holic fermentation  that  mimic  the  morbid  pro- 
cesses of  bacillary  phthisis. 

Thus  we  know  that  the  presence  of  the  tuber- 
cular germ  in  the  mouth  or  other  parts  of  the 
body  is  not  always  followed  by  tuberculosis. 
Analogously  we  know  that  the  presence  of  yeast 
germs  in  a  saccharine  solution  does  not  ahvays 


102     Mimicry  of  Animal  Tuberculosis. 

give  rise  to  alcoholic  fermentation.  The  solution 
must  contain  less  than  20  per  cent,  of  the  saccha- 
rine material.  Thus  the  specific  gravity  of  the 
solution  is  the  controlling  condition  in  the  activ- 
ity of  the  yeast  plant.  The  same  may  be  true  of 
the  human  body.  It  can  easily  be  understood 
that  in  the  human  body  the  specific  gravity  may 
vary.  Thus  an  exceedingly  fat  and  juicy  body 
would  be  of  lighter  specific  gravity  than  a  closely- 
knit,  hard,  muscular  body,  and  undoubtedly  the 
specific  gravity  of  the  body  has  something  to  do 
with  the  miorbid  action  of  many  of  the  germ 
phases  of  disease.  Nor  is  this  all.  Before  Pas- 
teur's enlightening  investigations  it  Vv^as  sup- 
posed that  the  yeast  germ  was  contained  in  the 
atmospheric  dust,  but  Pasteur  proved  conclu- 
sively that  this  was  not  the  case.  He  admitted 
atmospheric  air  and  its  dust  into  sterilized  tubes 
of  proper  saccharine  solutions  for  the  growth  of 
the  yeast,  but  the  alcoholic  fermentation  v/as 
never  set  up  in  solutions  thus  treated.  Then  the 
question  arose,  Where  did  the  yeast  plant  come 
from?  and  further  study  revealed  the  fact  that 
all  kinds  of  fruit  contained  on  their  surface  a  germ, 
termed  by  En  gel  "  apiculated  ferment  "  (car- 
pozyma.)  This  is  a  hibernating  germ,  and,  un- 
less the  fruit  is  bruised  and  its  containing  sugar 
in    due    proportion   brought   into    contact,    the 


Mimicry  of  Animal  Tuberculosis.     103 

g-erm  will  not  grow  or  produce  its  special 
changes.  This  plant  does  not  in  any  way  resem- 
ble the  ordinary  yeast  plant  unless  it  is  modified 
by  its  growth  in  a  fermenting  fluid.  May  we  not 
then  easily  suppose  that  some  germ-forms  exist 
normally  in  the  animal  tissues  prone  to  tubercu- 
lar diseases,  and  only  develop  into  the  forms  in 
which  we  find  them  when  some  anterior  morbid 
process  has  been  developed?  This  idea  is  con- 
cisely expressed  in  a  paper  read  before  the  Nev/ 
York  Medical  Association,  March  17,  1890,  by 
Dr.  James  R.  Leaming,  a  gentleman  who  has 
grown  old  in  the  study  of  this  disease.  He  says: 
"  I  have  seen  no  case  of  phthisis  that  could  not 
be  accounted  for  satisfactorily  without  supposing 
infection  or  contagion.  I  can  say  more.  I  have 
seen  no  case  of  phthisis  where  there  was  a  proba- 
bility of  primary  infection  with  no  other  cause. 

"  The  first  physical  evidence  of  dead  atoms  in 
the  system  is  their  extension  from  the  capillaries 
into  the  pleural  cavities,  as  damaged  leucocytes 
or  ptomaines  by  physical  diagnosis  and  this  may 
be  done  before  the  presence  of  the  bacilli  can  be 
detected  in  the  sputa.  The  bacillus  is  consequent, 
not  causative;  it  is  true  that  ptomaines  are  in  the 
blood  before  the  expression  of  the  leucocytes,  but 
as  a  rule,  not  in  abundance  sufficient  to  attract 
the  germs." 


104     Mimicry  of  Animal  Tuberculosis. 

This  explanation  of  one  phase  in  the  develop- 
ment of  tubercular  disease  will  coincide  exactly 
with  the  development  of  alcoholic  fermentation 
in  the  case  of  grapes.  Thus  on  the  surface  or  in 
connection  with  the  grape  is  a  hibernating  germ, 
and  this  germ  is  never  brought  into  activity  un- 
less the  grape  is  bruised  and  forms  a  solution, 
when  the  germ  becomes  active  and  changes  the 
sugar  into  alcohol  and  other  products  of  fermen- 
tation, wdiich  mimic  the  formation  of  ptomaines 
in  the  animal  economy. 

There  are  many  other  forms  of  vital  processes 
outside  of  the  animal  body  that  mimic  its  morbid 
processes.  All  these  forms  are  complicated, 
many  of  them  mysterious,  and  associated  with  an 
interminable  train  of  anterior  and  subsequent 
evolutions  to  the  germ  activity.  My  object  in 
alluding  to  those  enumerated  is  only  to  shovv'  the 
apparent  fallacy  of  our  imagining  that  because 
we  have  discovered  the  presence  of  a  minute 
germ,  w^e  are  also  in  possession  of  sufficient 
knowledge  of  the  morbid  processes  associated 
with  this  germ  to  indicate  a  rational  mode  of 
treating  the  disease  wdiere  the  germ  exists,  with- 
out knowing  definitely  how  much  other  condi- 
tions outside  the  germ  have  to  do  with  the  pro- 
cess. It  has  ever  been  one  of  the  characteristics 
of  scientific  men  to  make  sweeping  and  hasty  de- 


Mimicry  of  Animal  Tuberculosis.     105 

ductions  from  the  discovery  of  some  one  un- 
doubted fact.  I  do  not  in  any  manner  wish  to 
detract  from  the  honor  and  brilHancy  of  Koch's 
discovery,  but  I  wish  to  protest  against  the  tend- 
ency of  the  medical  mind  to-day  to  hang  every- 
thing on  the  bacihus.  For  instance,  if  the  bacillus 
was  the  only  cause  of  tuberculosis,  it  would  have 
to  be  viewed  in  the  light  of  a  foreign  body  within 
the  tissues,  and  we  know  that  foreign  bodies  al- 
ways set  up  inflammatory  action  and  subsequent 
suppuration,  which  is  not  always  the  history  of 
tubercular  processes.  These  are  sometimes  or- 
ganized or  cretefied.  There  is  a  germ  disease 
where  the  morbid  processes  depend  on  the  germ 
and  the  germ  alone,  and  an  abscess  is  ahvays 
form-cd  by  this  germ  (actinomycosis)  and  a  clean- 
ing out  of  the  abscess  and  total  eHmination  of  the 
germ  cures  the  morbid  process.  But  I  think  the 
presence  of  the  tubercular  bacilli  must  be  viewed 
in  somewhat  the  same  light  as  the  nut-gall  of 
Phylloxera.  In  this  the  presence  of  the  eggs  is 
not  the  cause  of  the  tubercular  growth,  because 
if  the  &gg  alone  were  deposited  in  the  leaf  it 
would  act  as  a  foreign  body;  it  is  the  material  that 
is  injected  into  the  leaf  at  the  same  time  as  the 
&gg  is  deposited  which  sets  up  such  an  action  in 
the  nutritive  processes  of  the  leaf  that  the  irrita- 
tion of  the  egg  is  entirely  overcome. 


io6     Mimicry  of  Animal  Tuberculosis. 

Without  much  stretch  of  the  imagination  we 
can  imagine  the  giant  cell  as  occupying  the  posi- 
tion in  the  tubercle  of  human  phthisis  that  the 
egg  of  the  Cynips  occupies  in  the  nut-gall.  Ac- 
cording to  this  view,  the  bacillus  would  be  the 
nutritive  material  causing  the  growth  of  the 
tubercle.  These  surmises  and  similes  could  be 
carried  on  ad  miinituni,  but  I  think  the  mimicry 
is  suggestive  enough  to  indicate  to  us  that  there 
is  vastly  more  to  be  known  of  human  tuberculosis 
than  merely  that  a  germ  is  present  in  a  mass  of 
morbid  material. 


ONE    OF    THE    APPARENT    REASONS 

WHY  MAN  IS  AFFLICTED  WITH 

TUBERCULOSIS.* 

The  human  race  is  grievously  afflicted  with 
tuberculosis,  and  it  seems  to  be  an  old,  old  enemy 
to  man.  There  is  no  organ  or  structure  in  his 
entire  anatomy  that  is  not  subject  to  the  invasion 
of  the  minute  forms  which  make  in  man's  econ- 
om.y,  somewhere  or  anywhere,  a  tubercle  for 
their  residence.  There  is  no  other  disease 
that  is  so  capricious,  so  versatile,  and  so  decep- 
tive. It  is  unlike  other  diseases,  because  there  is 
no  constant  road  in  which  it  travels;  it  attacks 
all  ages  and  conditions  under  any  and  all  appar- 
ent circumstances.  Often  and  again  man  will 
imagine  he  has  been  able  to  make  out  the  source 
of  this  stream  of  death,  and  finds,  after  years  of 
study  and  research,  other  numerous  sources  that 
are  just  as  much  entitled  to  the  distinction  as  the 
first  discovery.  For  many  years  it  was  estab- 
lished with  apparent  truthfulness  that  the  disease 
w^as  a  hereditary  affection,  but,  when  the  dead- 
house  was  entered  and  the  foetus  in  the  womb  of 

*  Read  before  the  American  Social  Science  Association,  August  31,  1893. 

107 


io8  Tuberculosis. 

the  victim  was  inA^estigated,  it  was  found  that 
with  very  rare  exceptions,  indeed,  did  the  minute 
organism  which  characterizes  the  disease  ever 
pass  the  gates  of  the  placental  circulation,  and 
so,  to-day,  it  is  not  classed  as  a  hereditary  affec- 
tion, but  as  an  acquired  disease.  We  are  quite 
confident  at  the  present  timic  that  true  tubercu- 
losis is  the  result  of  the  presence  and  growth  of 
a  small  organism  that  invades  the  tissues  and 
makes  for  itself  a  local  habitation,  which  we  term 
a  tubercle  from  its  resemblance  to  a  tuberculous 
plant.  At  first  it  is  insinuating  and  almost  if  not 
quite  imperceptible,  and,  like  Uriah  Heep,  very 
humble,  but,  as  the  colony  increases  and  its 
abode  enlarges,  it  begins  to  assert  its  presence, 
sometimes  by  simply  stimulating  the  activity  of 
the  structure  it  invades,  and  later  the  entire 
economy  takes  on  an  increased  activity,  bodily 
temperature  is  increased,  the  blood  circulation  is 
accelerated,  nutritive  processes  are  impaired, 
waste  exceeds  repair,  and  the  tuberculous  abode 
of  his  majesty,  the  bacillus,  breaks  down  into 
ruins,  and  the  crumbling  walls  enter  the  river  of 
life,  which  thus  becomes  putrid,  and  sepsis  over- 
powers the  victim.  As  to  the  little  germ  that 
causes  the  calamity,  we  know  not  whence  it 
came  nor  whither  it  goeth  after  its  dire  work  is 
accomplished. 


Tuberculosis.  109 

Man  is  not  the  only  animal  afflicted  with  tuber- 
culosis. Undoubtedly,  more  deaths  occur  among 
the  members  of  the  human  race  than  among  the 
lower  animals,  but  there  are  far  more  dairy  cows 
infected  with  tuberculosis,  in  proportion  to  their 
number,  than  in  the  human  family.  There  is  one 
very  good  reason  why  fewer  deaths  occur  among 
dairy  animals  than  among  mankind,  and  it  was 
this  discovery,  which  I  am  about  to  relate,  which 
led  me  to  the  conclusion  that  the  cow  was  the 
mischief-maker. 

The  reason  that  the  tuberculous  cow  is  not 
often  killed  by  the  tuberculous  process  is  found 
in  her  high  natural  bodily  temperature.  We 
know  pretty  conclusively  that  the  tubercle  bacil- 
lus requires  for  its  growth  and  multiplication  a 
temperature  above  the  normal  human  bodily 
heat,  and,  curiously  enough,  the  raised  tempera- 
ture of  the  human  subject  that  is  pathognomonic 
of  the  growth  of  tuberculous  masses  is  the  nor- 
mal bovine  temperature.  Consequently,  tubercle 
will  grow  in  the  cow  without  any  disturbance  of 
her  normal  temperature,  and  the  train  of  evil 
consequences  that  follows  the  effects  of  increased 
bodily  heat  does  not  occur  in  the  cow  from  an 
invasion  of  tuberculosis.  Therefore,  the  process 
goes  on  in  the  animal,  and,  unless  other  morbid 
conditions  supervene  to  increase  the  bovine  tern- 


no  Tuberculosis. 

perature,  the  tubercle  does  not  break  down  and 
cause  sepsis,  which  is  ahvays  the  cause  of  death 
where  the  primary  disease  is  tuberculosis.  When 
the  cow  dies  of  acute  miliary  tuberculosis  some 
other  than  the  existing  tuberculous  disease  has 
supervened  to  increase  her  temperature  and  in- 
terfere with  the  normal  condition  of  the  tubercle. 
And  right  here  is  another  curious  fact — namely, 
that  as  some  other  condition  than  tuberculosis 
must  arise  in  the  cow  to  cause  the  breaking  down 
of  the  tubercle  when  it  exists,  so,  contrariwise, 
some  other  morbid  aitection  than  tuberculosis 
must  first  increase  the  temperature  in  the  human 
subject  before  the  tubercle  bacillus  can  com- 
mence his  morbid  antics.  When  the  tubercle- 
building  has  commenced  by  reason  of  a  proper 
high  temperature,  the  growth  of  the  tubercle  and 
the  fermentative  action  of  the  multiplication  of 
the  bacillus  will  of  itself  continue  the  required 
heat,  and  this  continued  increased  temperature 
is  suf^cient  to  lower  nutrition  and  resistance,  and 
consequently  the  tubercle  finally  breaks  down,  in 
man  without  the  intervention  of  any  other  mor- 
bid condition,  as  is  required  in  the  cow,  to  cause 
the  same  septic  condition  that  kills  both. 

Now  let  me  enumerate  some  of  the  causes 
alleged  as  accounting  for  the  presence  of  tuber- 
culosis in  man,  and  you  will  see  that  all  of  these 


Tuberculosis.  m 

causes  are  at  work  with  our  dairy  animals  under 
the  present  modes  of  breeding  and  feeding  in 
the  so-called  best  milk  breeds. 

First  we  will  consider  breeding.  Vigor  and 
robustness  in  the  offspring  are  undoubtedly 
maintained  by  the  union  of  individuals  not  con- 
sanguineously  related.  Consanguinity  will 
always  attenuate  the  vigor  of  any  breed  of  ani- 
mals. Close  in-and-in  breeding  decreases  the 
size,  increases  nervous  intensity,  promotes  early 
maturity,  and  lowers  the  resistance  to  disease  by 
reason  of  the  delicacy  of  the  muscular  tissue.  In 
other  words,  to  use  an  old-fashioned  term,  con- 
sanguinity produces  scrofula.  Scrofula  is  a  con- 
dition which  we  all  recognize  as  one  which  seems 
to  make  the  individual  prone  to  phthisis. 

ScrofulojLis  females  in  the  human  race  usually 
secrete  an  abundance  of  milk,  because  in  scrofula 
there  is  an  unusual  tendency  of  glandular  en- 
largement and  activity.  As  the  mammary  is  the 
highest  type  of  glandular  structure,  it  is 
stimulated  to  increased  action.  A  scrofulous 
cow  is  usually  the  largest  milker,  and  the  closest 
kind  of  consanguinity  has  been  practiced  by 
cattle-breeders,  with  the  object  of  producing  a 
scrofulous  animal,  not  because  she  is  scrofulous, 
but  because  the  particular  form  she  represents 
are  the  largest  yielders  of  milk.     We  find,  too. 


112  Tuberculosis. 

that  consanguineous  breeding  has  been  alleged 
as  one  of  the  causes  of  tuberculosis  in  the  human 
race,  where  it  never  can  be  conducted  with  so 
close  and  intimate  blood  relatives  as  in  the  dairy 
animals.  So  here  we  have  at  work  in  the  cow 
one  of  the  alleged  causes  of  tuberculosis  in  man. 

Next  in  regard  to  climate.  The  absence  of 
phthisis  in  high,  dry,  mountainous  regions  has 
been  accounted  for  by  reason  of  the  altitude  and 
absence  of  moisture  in  the  atmosphere;  but  here 
occurs  a  somewhat  curious  fact — namely,  that 
the  cow  dairy  does  not  thrive  in  hrgh,  dry,  moun- 
tainous districts,  but  in  the  low,  swampy,  moist 
region,  where  the  succulent  and  lush  grasses 
grow,  is  the  place  where  the  cow  flourishes,  and 
it  is  in  these  regions  also  that  tuberculosis 
abounds  in  both  the  bovine  and  human  subjects'. 

No  name  has  shed  more  light  on  the  history 
of  phthisis  than  that  of  Laennec,  who  himself 
died  of  a  pulmonary  phthisis,  and  he  said  that  he 
knew  of  no  more  certain  cause  of  this  disease 
than  profound  or  prolonged  grief  or  melancholy. 
In  the  dairy  we  often  see  the  variety  of 
grief  represented  by  "  Rachel  weeping  for  her 
children."  The  maternal  instinct  is  a  strongly- 
marked  characteristic  in  the  dairy  cow,  and, 
as  grief  is  one  of  the  minor  conditions  which 


Tuberculosis.  113 

favor  the  development  of  tuberculosis  in  man, 
it  must  be  allowed  as  a  factor  also  in  the  case  of 
the  cow. 

There  is  no  doubt  that  nutrition  plays  as  im- 
portant a  role,  aetiologically,  in  the  development 
of  tuberculosis  as  any  other  single  factor  outside 
of  the  actual  presence  of  the  bacillus.  Defective 
nutrition,  either  from  lack  of  variety,  insufficient 
quantity,  or  interference  with  the  nutritive  func- 
tions in  any  manner,  all  cause  lowered  resistance 
to  such  an  extent  as  to  favor  the  invasion  of 
tubercular  infection.  This  is  true  as  relating  to 
the  human  race,  and  we  must  give  it  some  weight 
as  a  factor  in  the  development  of  tuberculosis  in 
the  lower  animals.  Owing  largely  to  the  cheap- 
ness of  milk,  if  the  dairyman  is  to  feed  his  animals 
with  the  materials  most  favorable  for  nutrition, 
food  must  be  cheap  and  stimulating  to  glandular 
structures.  With  rare  exceptions  do  we  ever 
find  the  cow  getting  the  whole  grist  of  any  of  the 
nutritious  grains.  The  materials  classified  by 
the  dairyman  as  the  best  food  for  cows  are  the 
refuse  from  hominy  mills,  starch  factories,  glu- 
cose factories,  breweries,  distilleries,  and,  in  fact, 
every  refuse  that  is  left  after  working  up  the 
nutritious  cereals  and  getting  the  best  out  for  the 
nourishment,  of  some  other  animal.  Even  on 
the  farms  the  poorer  varieties  of  hay  and  grasses 
8 


114  Tuberculosis. 

are  always  designated  as  cow  food.  So  we  have 
here  at  work  in  the  dairy  animal  another  alleged 
cause  of  tuberculosis  in  man. 

Phthisis  in  the  human  subject  is  most  fre- 
quently associated  with  sedentary  occupations. 
Tailors,  seamstresses  and  other  hand  workers 
present  more  than  the  usual  percentage  of  deaths 
from  this  disease.  The  same  is  true  of  the  vic- 
tims of  forced  confinement  from  whatever  cause. 
Baer's  statistics  of  prisons  show  among  the  in- 
mates a  mortality  four  times  as  great  as  outside. 
While  the  average  total  mortality  of  phthisis  is 
15  per  cent,  of  the  total  mortaHty  of  the  world 
at  large,  in  prisons  it  amounts  to  40  or  50  per 
cent.  The  mortality  of  manufacturers  is  twice 
as  great  as  that  of  outside  occupations,  while  the 
cloisters  of  the  Old  World  show  a  phthisis  mor- 
tality of  50  per  cent. 

During  the  winter  months  the  cow  is,  as  a 
rule,  subjected  to  close  and  prolonged  confine- 
ment in  an  ill-ventilated  and  foul  stable,  and  if 
confinement  can  be  considered  a  factor  in  the 
development  of  the  disease  in  man,  it  must  be 
reckoned  as  a  factor^with  the  dairy  animal.  Pro- 
longed lactation  is  another  cause  of  phthisis  in 
the  human  subject,  but  no  woman  is  subjected  to 
so  prolonged  and  continuous  lactation  as  is  re- 
quired of  the  dairy  animal. 


Tuberculosis.  115 

From  the  time  that  she  is  two  years  of  age  or 
under  she  is  milked  continuousl}^  with  the  ex- 
ception of  a  few  weeks  before  her  parturition; 
and  not  only  is  she  milked,  but  she  is  pregnant 
during  the  greater  part  of  the  time  that  she  is 
yielding  her  milk.  And  so  we  might  go  on  to 
enumerate  other  conditions  that  have  been 
accounted  as  causes  of  the  disease  in  the  human 
subject,  and  we  should  find  them  all  at  work  in 
the  dairy  and  some  of  them  even  intensified  in 
the  case  of  the  cow.  Therefore  is  it  to  be  won- 
dered at  that  the  cow^  is  a  tuberculous  animal? 
And  if  the  disease  is  contagious  and  conveyed 
from  one  animal  to  another,  what  other  animal 
associated  withmiankind  is  more  likely  to  convey 
to  him.  this  fell  disease?  Man  is  more  closely 
associated  with  the  dairy  cow  than  with  any 
other  of  his  domestic  animals.  He  drinks  her 
milk  and  eats  her  flesh,  and  if  she  harbors  the 
germ  we  can  see  that  every  condition  in  her  life 
and  her  peculiarly  high  normal  temperature,  the 
degree  of  w^hich  is  precisely  that  required  for  the 
propagation  of  this  organism  as  we  -understand 
the  life  history  of  the  tubercle  bacillus,  favors  its 
transmission.  Is  it  unnatural  to  suppose  that 
man  becomes  infected  from  this  animal?  And 
so  one  of  the  apparent  reasons  why  man  is  af- 
flicted  with   tuberculosis  is   found   as  a   conse- 


Ii6  Tuberculosis. 

quence  of  his  grave  errors  in  feeding  and  caring 
for  one  of  the  most  useful  and  numerous  of  his 
domesticated  animals.  Furthermore,  I  am  still 
convinced  of  the  fact  that  where  the  inbred  scrof- 
ulous cow  exists,  there  tuberculosis  in  all  its 
forms  prevails  among  the  human  race,  and  where 
this  animal  is  absent  the  inhabitants  enjoy  an 
immunity. 


THE  DANGER  OF  MILK  FROM  TUBER- 
CULOUS COWS.^ 

The  domesticated  bovine  animal  appears  to 
be,  above  all  other  animals,  subject  to  tuberculo- 
sis. This  animal  is  capable  of  bearing  the  tuber- 
culous processes  in  their  natural  state — that  is, 
without  breaking-  down  and  producing  sepsis, 
which  is  the  cause  of  death  in  the  disease  known 
variously  as  phthisis,  consumption,  and  so  forth. 
In  other  words,  a  dairy  cow  will  have  fulfilled  her 
functions  with  profit  to  her  owner,  and  only 
when  she  reaches  the  butcher  is  it  discovered 
that  tuberculous  growths  are  present  in  various 
parts  of  her  body.  No  other  animal  that  I  know 
can  be  tuberculous  for  so  long  a  period  without 
exhibiting  evidences  of  the  disease,  and  hence 
the  diagnosis  of  this  disease  in  the  domestic  cow 
is  often  a  very  difficult  matter. 

The  reason  why  the  domestic  cow  bears  the 
tuberculous  processes  without  their  breaking 
down  is  by  reason  of  her  natural  bodily  tempera- 

*  Read  at  the  Annual  Meeting  of  the  New  York  State  Medical  Society, 

1892. 

117 


ii8        Milk  from  Tuberculous  Cows. 

ture,  her  normal  average  temperature  being 
T02j°.  This  I  have  ascertained  from  personal 
observation  on  hundreds  of  apparently  healthy 
animals,  extending  over  several  years.  This  is 
about  the  temperature  that  arises  in  the  human 
subject  during  the  stage  of  active  tuberculization, 
and  this  high  temperature  in  the  human  subject 
is  a  prominent  etiological  factor  in  the  constitu- 
tional disturbance,  eventuating  in  the  breaking 
down  of  the  tubercle  that  leads  to  the  sepsis 
producing  death.  Now,  this  normal  tempera- 
ture of  the  covv'  admits  of  the  growth  of  the 
tubercle  without  constitutional  disturbance,  and 
consequently  the  animal's  resistance  is  retained 
and  tuberculous  processes  attain  enormous  pro- 
portions without  affecting  the  general  health  or 
usefulness  of  the  anim.al.  Therefore,  in  order 
that  a  cov/  miay  develop  the  tuberculosis  that 
kills,  some  other  morbid  agency  (traumatism, 
puerperal  septicaemia,  etc.)  must  supervene  to 
setup  the  breaking-down  process  in  the  tubercle. 
When  acute  miliary  tuberculosis  takes  place  in 
the  cow,  old  tuberculous  processes  are  always 
found,  and  the  temperature  is  then  increased 
only  a  degree  and  a  half.  Acute  miliary  tuber- 
culosis in  the  cow^  is  a  comparatively  rare  disease, 
and  hence  many  dairymen,  cattle-dealers,  and 
breeders  imagine  that  tuberculosis  is   rare,   or 


Milk  from  Tuberculous  Cows.        119 

more  rare  than  is  reported  to  exist  in  dairy  cattle, 
for  this  reason  alone,  or  because  so  few  cases  die 
in  comparison  with  the  number  of  animals 
afifected.  Therefore,  these  men  do  not  see  the 
latent  evidences  of  disease,  their  standard  of  per- 
fect health  in  dairy  animals  being  the  ability  of 
the  animal  to  perform  its  functions  with  profit 
to  its  owner;  and  having  no  comparative  stan- 
dard of  health,  they  regard  the  animal  as  sick 
only  when  it  refuses  to  yield  milk  or  fatten  for 
the  butcher. 

Now,  what  is  the  danger  of  milk  from  tuber- 
culous cows  when  used  as  human  food?  Of 
course,  an  animal  affected  with  acute  miliary 
tuberculosis  that  kills — and  this  is  the  only  form 
of  tuberculosis  that  kills  an  animal — in  this  form 
the  milk-secretions  are  suppressed  very  soon 
after  the  onset  of  the  general  infection;  and,  as 
the  disease  is  comparatively  rare,  milk  from  these 
animals  is  not  so  common  as  the  literature  on  the 
subject  would  lead  one  to  suppose,  while  the 
chronic  latent  form  of  the  disease  is  always  more 
or  less  present  in  the  ordinary  dairies  that  supply 
milk  for  food;  and  it  is  very  safe  to  assume  that 
everyone  that  drinks  milk  as  it  is  furnished  to 
cities  takes  milk  from  animals  affected  with  tu- 
berculosis— the  chronic  form  always,  the  acute 
form  occasionally.     So  the  question,  as  it  seems 


I20        Milk  from  Tuberculous  Cows. 

to  me,  should  be,  When  is  the  human  subject  fit 
to  take  the  milk  from  tuberculous  cows  with  im- 
punity? for  there  can  be  little  doubt  but  that  in 
a  robust  state  of  health  the  human  being  can 
ingest  with  impunity  the  food  from  tuberculous 
animals,  and  probably  in  many  conditions  of  im- 
paired health  such  food  can  be  taken  wdthout 
apparent  danger.  Of  course,  tuberculosis  can- 
not be  studied  in  the  same  light  as  other  infec- 
tious diseases,  because  the  introduction  of  the 
poison  into  the  system  to-day  may  require  a  year 
or  ten  years  before  it  is  developed  into  a  disease. 
It  is,  therefore,  almost  utterly  impossible  for 
anyone  to  say  in  a  giA^en  case  where  the  infection 
came  from.  In  the  studv  of  this  disease,  takinsf 
isolated  or  individual  cases,  where  apparent 
cause  and  effect  stood  in  close  relationship,  it  is 
simply  a  coincidence,  and  is  highly  misleading. 
I  have  watched  the  medical  literature  on  the  sub- 
ject very  carefully  for  a  number  of  years,  and 
there  are  a  fevr  cases  cited  where  the  evi- 
dence pointed  strongly  to  the  domestic  cow  as 
the  direct  source  of  the  infection.  In  other 
cases,  in  v\hich  I  have  myself  known  children 
brought  up  on  the  milk  of  tuberculous  cows,  no 
evil  has  as  yet  resulted,  and  I  have  never  been 
able  to  associate  any  case  of  tuberculosis  in  the 
human  subject,  infant  or  adult,  directly  with  a 


Milk  from  Tuberculous  Cows.        121 

tuberculous  cow.  I  know  a  girl  to-day,  thirteen 
years  old,  whose  food  for  two  years  after  wean- 
ing was  mainly  the  milk  of  a  tuberculous  cow. 
The  cow,  of  course,  was  then  affected  with 
chronic  tuberculosis,  and  ultimately  succumbed 
to  general  infection.  The  milk  was  given  to  this 
child  directly  from  the  cow,  and  warm,  and  the 
child  has  always  been  remarkably  healthy. 
About  two  years  ago  a  friend  of  mine  wanted  me 
to  see  his  cow  and  say  what  was  the  matter  with 
her.  I  found  her  suffering  from  acute  pulmon- 
ary tuberculosis  of  the  miHary  type.  She  was 
killed,  and  we  found  old  tuberculous  processes 
in  the  mesentery  glands.  These  were  not 
broken  down,  but  a  large  mass  in  the  medias- 
tinum was  broken  down,  and  seemed  to  be  the 
source  from  whence  the  general  infection  spread. 
The  laryngeal  glands  were  also  chronically  en- 
larged. This  was  a  family  cow,  and  furnished 
three  children  of  the  household,  aged  respect- 
ively from  tv/o  to  seven  years,  with  their  daily 
supply  of  milk.  These  children,  all  of  remark- 
ably robust  health,  are  perfectly  well  to-day. 
But  this  kind  of  negative  testimony  proves  no 
more  than  the  positive  testimony  that  has  been 
thus  far  accummlated.  The  disease  must  be 
studied,  not  by  isolated  cases,  but  on  a  broad 
field.     There  are  some  ludicrous  instances  in  the 


122        Milk  from  Tuberculous  Cows. 

history  of  the  disease  illustrating  the  fallacy  of 
drawing  deductions  from  circumscribed  observa- 
tions: ''  In  1677  twelve  students  who  had  taken 
their  repast  in  the  Consistorium  of  Leipsig,  died. 
At  the  inquest  it  was  proved  that  the  hotel- 
keeper  had  given  them,  in  addition  to  other  food 
of  a  bad  description,  the  flesh  of  emaciated  and 
infected  cows,  w^hose  viscera  were  covered  with 
a  great  number  of  vesicles,  of  tubercular  nodules, 
and  of  purulent  tumors.  Externally  this  flesh 
did  not  offer  any  abnormal  appearance."  In  the 
light  of  our  knowledge  in  the  present  day  it  is 
safe  to  assume  that,  whatever  else  these  students 
may  have  died  from,  it  was  not  simply  the  tuber- 
culous meat  that  killed  them.  Nevertheless 
this  unfortunate  accident  stirred  up  an  exagger- 
ated public  feehng  on  the  continent  of  Europe, 
and  most  countries  passed  stringent  laws.  Three 
years  after  the  Leipsig  accident  the  German 
States  enacted  very  severe  measures  to  prevent 
the  sale  of  meat  from  tuberculous  cattle. 
Butchers  were  afraid  to  have  anything  to  do  with 
animals  showing  the  least  trace  of  the  disease; 
the  carcasses,  and  even  the  instruments  used  in 
slaughtering  such  cattle,  were  turned  over  to  the 
public  executioner.  These  measures  involved  a 
heavy  loss  to  the  cattlemen;  and  it  was  found 
that  the  executioners  did  not  destroy  the  dis- 


Milk  from  Tuberculous  Cows.        123 

eased  carcasses,  but  consumed  them  in  their  own 
families  or  sold  them  to  others,  and  that  no  in- 
jury resulted  from  the  use  of  this  flesh.  Then  the 
pendulum  began  to  swing  in  the  opposite  direc- 
tion, and  the  medical  men  began  to  teach  that 
tuberculosis  was  not  a  contagious  disease,  and 
that  the  flesh  could  be  eaten  with  impunity.  In 
fact,  the  meat  of  tuberculous  cows  was  publicly 
advertised  as  of  good  quality.  Zuierlioz,  a  doc- 
tor of  medicine  and  philosophy  at  Bruckenau, 
took  twenty-five  pounds  of  flesh  from  a  tuber- 
culous ox  and  ate  it,  in  order  to  show  that  such 
meat  was  not  injurious.  This  doctor  also  pre- 
pared a  broth  made  from  the  tuberculous 
nodules  of  the  ox,  and  drank  it  in  the  market- 
place before  a  large  number  of  people.  Then 
about  this  time  the  various  governments  began 
to  rescind  the  various  stringent  regulations,  and 
the  prejudice  against  the  use  of  such  food  ceased 
to  exist.  Now,  in  our  day,  with  the  increased 
knowledge  we  possess  as  to  the  etiology  of  the 
disease,  stimulating  increased  discussion  and  en- 
larging the  literature  on  the  subject,  the  public 
are  in  danger  of  adopting  the  same  unreasoning 
prejudice.  I  say  ''  unreasoning  prejudice,"  not 
because  I  underestimate  the  danger  of  the  pres- 
ence of  tuberculous  animals  as  food-producers, 
but  because  the  methods  heretofore  adopted  are 


124        Milk  from  Tuberculous  Cows. 

inadequate  and  one-sided.  I  firmly  believe  that 
all  the  tuberculosis  that  afflicts  the  human  race 
is  derived  from  the  domesticated  bovine,  be- 
cause the  only  people  on  the  face  of  the  earth 
who  enjoy  immunity  from  tuberculosis  are  those 
who  do  not  harbor  domesticated  tuberculous 
animals.  If  this  broad  statement  is  true,  what 
does  it  signify?  Can  we  control  the  disease  by 
condemning  animals  only  when  they  come  to 
the  butcher,  and  allowing  the  milk  to  be  used 
until  he  makes  the  diagnosis  for  us?  If  con- 
sumption is  a  contagious  disease,  and  the  human 
race  stands  in  danger  of  the  contagium  coming 
from  their  most  useful  food  animals,  would  it 
not  be  wise  to  regulate  the  breeding  of  such  ani- 
mals? There  are  bovines  that  are  reported  to 
enjoy  a  total  immunity  from  tuberculosis,  and  so 
it  is  possible  for  us  to  produce  a  breed  that  will 
not  menace  the  human  race.  But  until  the  vast 
number  of  earnest  workers  who  are  moulding 
medical  and  scientific  opinion  unite  their  forces 
in  this  direction,  and  until  we  get  an  animal  not 
tuberculous,  wx  must  use  our  best  efforts  to 
avert  the  dangers  that  now  threaten  us.  I  do 
not  believe  that  anybody  can  tell  at  what  stage 
of  tuberculosis  in  the  cow  the  milk  is  safe  or  be- 
coming dangerous.  We  have  statistical  facts 
enough  pointing  to  the  morbid  conditions  in  the 


Milk  from  Tuberculous  Cows.        125 

human  subject  creating  a  receptivity  to  the  con- 
taeiuni.     We  know  that  nearly  50  per  cent,  of 
diabetic  subjects  are  carried  off  by  pulmonary 
phthisis.     Surely  we  should  guard  a  patient  with 
this  disease  from  the  possibility  of  contagion; 
also  in  all  other  conditions  of  emaciation  and 
lowered  resistance  in  the  adult.     With  children 
1  have  no  doubt  that  the  danger  is  far  greater, 
as  their  food  is  solely  or  chiefly  milk.     I  sincerely 
believe  that  a  child  in  perfect  health  can  take  the 
milk  of  a  tuberculous  cow  with  impunity;  but  a 
child  that  is  born  with  a  feeble  constitution,  or 
of  tuberculous  parent  or  parents,  or  suffering 
from  cachexia,  or  any  of  the  wasting  diseases, 
should  not  be  allowed  to  have  milk  from  a  tuber- 
culous cow,  no  matter  what  stage  of  the  disease 
miay  exist  in  the  cow.     As  to  sterilizing  or  boil- 
ing the  milk  for  these  children,  the  process  may 
or  may  not  eliminate  the  disease  germs — and  we 
have  pretty  good  evidence  that  boihng  does  not 
— but  we  are  certain  that  either  process  lowers 
the  nutritive  value  of  a  food  already  belov/  par 
(if  from  a  tuberculous  cow)  by  reason  of  the  dis- 
eased condition  of  the  animal  itself.     So  in  the 
same  cases  where  the  milk  of  tuberculous  ani- 
mals is  to  be  prohibited,  the  absolute  necessity 
of  the  highest  type  of  food  also  necessitates  the 
exclusion  of  boiled  or  sterilized  milk  of  any  kind. 


126        Milk  from  Tuberculous  Cows. 

As  all  cows  are  not  tuberculous,  it  is  perfectly 
feasible  to  select  animals  to  supply  infant  food. 
As,  however,  the  chronic  forms  of  tuberculosis  in 
the  dairy  cow  are  not  easily  recognized,  the  medi- 
cal man  knows  little  or  nothing  about  the  cow; 
and,  as  the  American  veterinary  schools  have 
paid  less  attention  than  the  subject  deserves, 
there  are  few  people  who  are  able  to  detect  the 
earlier  symptoms.  The  necessity  for  more 
definite  knowledge  of  the  cow  herself  by  all 
practitioners  is  evident,  so  that  when  it  becomes 
necessary  to  prohibit  the  use  of  food  that  is  apt 
to  kill,  there  should  be  more  people  able  to  de- 
tect the  morbific  conditions  at  work  in  the  food- 
producing  animal.  We  can  safely  assert  that  in 
our  time  tuberculosis  will  not  be  entirely  elim- 
inated from  the  dairy  cow.  We  are  approaching 
the  period  when  it  will  be;  meanwhile,  therefore, 
let  us  guard  the  susceptible,  and  aid  in  the  ad- 
vance toward  the  annihilation  of  one  source  of 
danger  to  the  human  race. 


[Reprint  from  New  York  Medical  Journal,  August  14,  1897.] 

WHAT  MUST  WE  DO  TO  BE  SAVED 
FROM  TUBERCULOSIS?* 

You  may  remember  the  story  of  Paul  and 
Silas:  During  their  missionary  work  in  Thya- 
tira  they  found  a  young  woman  possessed  of  a 
spirit  of  divination;  they  removed  from  her  this 
spirit,  and  thus  interfered  with  her  masters,  who 
used  her  as  a  means  of  making  m^oney.  The 
apostles  were  imprisone'd  for  interfering  with  a 
commercial  enterprise,  and  while  they  were  in 
prison  an  earthquake  occurred  that  destroyed  the 
building,  and  by  this  means  all  the  prisoners  were 
released.  The  jailer  in  his  intense  chagrin  at  the 
escape  of  the  prisoners,  v/as  about  to  commit 
suicide  when  Paul  cried  out  to  him,  ''  Do  thyself 
no  harm!  "  and  he,  knowing  that  Paul  and  Silas 
possessed  a  knowledge  of  salvation,  said  to  them, 
"  Sirs,  what  must  I  do  to  be  saved?  " 

Now,  in  almost  the  same  spirit  of  missionary 
enterprise,  we  are  trying  to  cast  out  an  evil  spirit 

*  Read  before  the  Medical  Society  of  the  County  of  Westchester,  N.  Y., 

May,  1897. 

127 


128       What  Must  We  Do  to  be  Saved? 

from  a  bovine  female;  this  female  represents  a 
great  business  interest,  and  many  of  the  men  who 
own  this  female  do  not  want  us  to  interfere  with 
their  com.mercial  interests,  but  the  people,  like 
the  frightened  jailer,  are  calling  out  to  us,  ''  Sirs, 
v^hat  must  we  do  to  be  saved?  "     I  think  it  can 
be  safely  said  that  many  of  us  know  that  our 
present  condition  is  dangerous.     Both  by  omis- 
sion  and   commission  we  are  far  from   saving 
grace.     The  taint  of  consumption  is  in  us  and 
also  in  our  neat  cattle,  and  in  this  respect  there  is 
no  health  in  us.     Therefore  the  gospel  question 
naturally  occurs,  What  must  v;e  do  to  be  saved? 
There  is  a  coincident  distribution  of  bacillary 
tuberculosis  in  the  human  and  bovine  species. 
This  disease  can  be  conveyed  from  one  anim_al  to 
another.     W^e  eat  and  drink  the  meat  and  milk 
of  the  dairy  cow,  and  this  animal  only  comes  in 
contact  by  association  with  a  very  sm.all  propor- 
tion of  the  humian  race.     In  her  food  she  takes 
nothing  that  was  part  of  us,  while  we  drink  her 
milk  as  lonsf  as  she  lives  and  then  devour  her 
body.    Each  single  animal  is  thus  distributed  as 
food  to  hundreds  of  the  human  order.    If  the  dis- 
ease can  be  conveyed  in  food  it  requires  no  argu- 
mient  to  point  out  which  of  these  species,  the  hu- 
m.an  or  bovine,  is  most  dangerous  to  the  other. 
I  have  repeatedly  stated  what  I  still  firmly  be- 


What  Must  We  Do  to  be  Saved?       129 

lieve,  that  all  the  tuberculosis  afflicting  the  hu- 
man race  comes  from  the  dairy  cow  either  di- 
rectly or  remotely,  but  to  avoid  argument,  it  is 
safe  to  say  that  if  the  dairy  cow  were  not  afifected 
with  tuberculosis  there  would  be  much  less  of  this 
affliction  in  the  human  race.  So,  to  answer  the 
question,  we  can  say,  "  Cure  the  bovine  race," 
and  this  can  not  be  done  with  the  political  syringe 
man.  It  can  only  be  accomplished  by  rational 
hygiene,  proper  breeding,  feeding,  and  treatment, 
and  when  the  attempt  is  made  to  cure  it  in  this 
manner  many  of  you  will  be  saved  as  surely  from 
tuberculosis  as  Paul  and  Silas  thought  the  fright- 
ened jailer  was  saved  from  sin. 

In  looking  back  over  marked  episodes  in  the 
history  of  the  human  race,  one  characteristic 
stands  out  in  bold  relief,  and  that  is  the  tendency 
of  the  human  famil3^  when  some  great  discovery 
is  made,  to  go  to  either  extreme  and  thus  delay 
the  enjoyment  of  the  discovered  golden  mean 
that  lies  always  between  the  two  extremes. 

The  history  of  vaccination  is  an  illustration;  so 
is  the  development  of  the  common-sense  cleanli- 
ness into  Listerism.  In  truth,  virtue  lies  between 
two  extremes,  and  both  of  these  extremes  are 
vices.  Between  foolhardiness  and.  cowardice 
there  is  true  courage;  between  the  miser  and  the 
spendthrift  is  the  prudent  man.  Now,  there  lies 
9 


I30       What  Must  We  Do  to  be  Saved? 

before  us  the  great  and  virtuous  necessity  to 
eliminate  from  the  bovine  race  the  taint  of  tuber- 
culosis. This  virtuous  necessity  lies  between  two 
extremes;  one  is  to  let  matters  alone,  the  other 
is  represented  by  the  frantic  efforts  of  State 
boards  to  stamp  out  the  disease  by  killing  a  few 
of  the  animals  afSicted,  and  not  attempting  to  in- 
terfere with  the  conditions  that  generate  the  dis- 
ease. The  present  effort  to  stamp  out  tuberculo- 
sis from  the  dairy  cattle  of  this  country  is  as  ab- 
surd as  it  would  be  to  attempt  to  stay  an  epidemic 
of  typhoid  fever  by  killing  every  one  who  con- 
tracted the  disease  and  paying  no  attention  to  the 
source  of  contagion.  I  have  watched  carefully 
for  years  the  action  of  State  authorities  in  their 
attempts  to  eliminate  tuberculosis  from  the  dairy, 
and  I  firmly  believe  that  more  positive  injury  has 
been  done  by  their  extreme  variance  from  the 
proper  course  than  would  have  resulted  from 
leaving  the  matter  entirely  alone.  Let  me  give 
you  an  illustration  among  the  many  I  have  ob- 
served. I  know  one  dairy  that  has  been  visited 
twice  by  inspectors  with  syringe  and  lymph. 
This  stable  has  always  been  positively  dirty,  ill- 
ventilated,  with  poverty  and  carelessness  to  make 
all  the  other  conditions  just  necessary  to  develop 
tuberculosis  in  an  improperly  bred  animal.  The 
inspectors  have  killed  off  their  quota  of  animals 


What  Must  We  Do  to  be  Saved?       131 

from  this  stable  and,  without  hygienic,  dietetic, 
or  any  other  improvement  in  the  environment  or 
care,  the  owner  was  simply  left  poorer,  and  so 
forced  to  buy  a  lower  grade  of  cows,  to  fill  his 
denlike  place  with  more  tuberculosis.  There 
must  be  a  cause  for  the  large  number  of  cows  that 
are  afflicted  with  tuberculosis,  and  is  it  not  ordin- 
ary plain  common-sense  to  assume  that  the  place 
to  attack  the  disease  is  at  its  fountain  head?  We 
all  know  that  close  confinement,  poor  food,  pro- 
longed lactation,  early  and  prolific  maternity, 
consanguineous  breeding,  all  or  any  of  these  con- 
ditions favor  the  development  of  bacillary  tuber- 
culosis, and  all  these  are  the  common  conditions 
of  the  dairy,  with  the  addition  of  dirt  and  care- 
lessness. The  statute  laws  of  this  State  and  of 
many  others  in  the  Union  are  sufficient,  if  hon- 
estly and  conscientiously  enforced,  to  make  a  bet- 
ter beginning  in  stamping  out  the  disease  than  if 
ten  times  the  amount  of  money  that  had  been 
asked  for  by  the  different  State  boards  of  health 
had  been  granted  and  put  into  the  hands  of  the 
politicians  as  pay  for  working  the  syringe,  lymph, 
and  thermometer. 

There  is  no  branch  of  domestic  science  that  has 
been  so  studiously  neglected  as  bovine  pathology. 
The  term  ''  cow  doctor  "  has  always  been  used 
among  veterinarians  as  a  designation  of  stupidity. 


132       What  Must  We  Do  to  be  Saved? 

When  I  began  the  study  of  bovine  medicine  I 
could  not  find  anywhere  in  the  world  a  text-book 
giving  the  correct  bovine  temperature.  The 
veterinary  colleges  have  kept  equine,  canine,  and 
even  feline  pathology  up  to  the  times,  but  the 
cow  in  the  college  has  received  the  same  treat- 
ment that  she  has  on  the  farm,  been  put  into  the 
basement  to  get  what  nothing  else  would  take — 
the  refuse. 

What  we  want  is  intelligent  bovine  veterin- 
arians, men  who  do  not  require  Koch's  doubtful 
lymph,  but  those  who  are  possessed  of  a  proper 
knowledge  of  the  hygienic  conditions  necessary 
to  insure  the  health  of  animals,  and  to  discover 
the  existence  of  other  diseases.  Tuberculosis  is 
undoubtedly  a  devastating  scourge  to  the  human 
race,  and  it  comes  largely  if  not  entirely  from  the 
bovine  race.  We  can  have  dairy  cows  that  are 
not  afflicted  with  it,  but  not  by  waiting  till  they 
contract  the  disease,  and  then  killing  them.  The 
disease  itself  will  do  the  killing  if  it  is  given  time. 
What  w^e  want  is  doctors  who  can  prevent  and 
thus  cure  without  killing,  and  such  doctors  can 
save  thousands  of  infants'  lives  by  eliminating 
from  the  dairy  other  diseases  and  conditions  that 
go  w^th  tuberculosis  in  our  dairies,  but  that  kill 
quicker  than  tuberculosis.  This  can  be  largely 
accomplished  without  any  change  in  the  present 


What  Must  We  Do  to  be  Saved?       133 

laws:  All  that  is  required  is  honest  and  intelli- 
gent bovine  veterinarians.  The  spirit  which  at 
present  seems  to  animate  some  dairy  inspectors 
is  revealed  by  the  following  letter  which  I  quote 
from  the  Medical  Review  of  Reviews: 

"  Dr.  J.  M.  O'Neil,  of  Buffalo,  writes  to  the 
editor  of  the  Buifalo  Medical  Journal  as  follows: 
Sir:  I  send  the  following  account  of  some  cases 
which  have  been  brought  to  my  notice,  exempli- 
fying the  manner  in  which  the  bacilli  of  tubercu- 
losis may  be  conveyed  through  the  agency  of 
milk.  The  details  of  the  following  cases  have 
been  supplied  to  me  by  a  veterinary  inspector, 
who  was  engaged  in  his  duties  in  Cattaraugus 
county,  some  sixty  miles  distant  from  Buffalo. 
When  there  he  was  requested  by  a  farmer  to  in- 
spect and  test  his  two  herds  of  cows.  He  com- 
plied with  the  request,  and  in  the  first  herd,  num- 
bering eighty,  he  found  eight  to  be  infected  with 
tuberculosis,  and  in  the  remaining  herd  he  found 
twenty-five  out  of  a  total  of  thirty  animals,  in- 
fected. A  neighboring  farmer  then  asked  the  in- 
spector to  test  his  herd.  He  did  so  and  found 
all  healthy.  The  calves  bred  from  some  of  the 
cows  were  then  tested,  and  it  was  discovered  that 
many  were  infected.  The  owner  of  the  calves 
gave  as  a  very  plausible  reason  for  the  infection  the 
fact  that  he  was  in  the  habit  of  buying  skim  milk 


134       What  Must  We  Do  to  be  Saved? 

and  buttermilk,  with  which  to  feed  the  calves, 
from  farmers  living  in  the  immediate  district,  and 
among  others  from  whom  he  procured  this  milk 
was  the  farmer  whose  herd  the  veterinary  inspec- 
tor had  tested  and  found  several  of  the  cows  to 
be  suffering  from  tuberculosis.  Of  course,  the 
foregoing  account  only  goes  further  to  prove  the 
already  well-known  fact  of  the  danger  of  spread- 
ing contagion  by  milk  ...  In  these  particular 
cases,  however,  the  danger  affects  Buffalo  rather 
closely,  for  I  also  ascertained  from  the  inspector 
that  milk  from  these  diseased  herds  was  daily 
brought  into  Buffalo  and  sold  on  the  streets  by 
peddlers.  The  names  of  the  peddlers  were,  as  a 
matter  of  course,  withheld  from  me." 

If  it  were  not  sad  it  would  be  funny  to  see  a 
great  State  like  New  York  paying  dairy  inspec- 
tors to  discover  the  source  of  m.ilk  supply  that 
conveys  tuberculosis  to  calves,  and  refusing  to 
give  the  physician  the  necessary  information  that 
would  enable  him  to  guard  his  patients  who  were 
in  peril  from  the  same  source.  But,  then,  this 
inspector  is  not  called  on  to  kill  the  babies  if  they 
contract  the  disease,  but  it  means  more  work  for 
him  if  the  disease  is  scattered  among  the  herds  of 
cattle  in  his  district.  This  ridiculous  condition  of 
affairs  will  continue  until  honest  common  sense 
indicates  to  our  health  authorities  how  to  attack 


What  Must  We  Do  to  be  Saved?       135 

the  great  danger  emanating  from  the  cow  stables 
all  over  the  land.  What  is  the  whole  foundation 
of  Listerism  but  cleanliness?  If  the  surgeon  of 
years  ago  had  been  told  that  he  was  criminally 
filthy  when  he  carried  his  instruments  in  a  beau- 
tiful-looking, deep-piled,  velvet-lined  case,  and, 
after  opening  a  malignant  abscess  or  bubo,  he 
simply  wiped  his  instrument,  to  make  the  blade 
bright  and  prevent  it  rusting,  he  would  have  re- 
sented the  accusation  as  a  malicious  libel.  But 
to-day  he  could  be  convicted  of  criminal  careless- 
ness for  the  same  thing  by  a  due  process  of  law. 
Antisepsis  is  just  plain,  common-sense  cleanli- 
ness. Dirt  has  been  defined  as  matter  in  the 
wrong  place.  Growing  plants  thrive  and  flourish 
in  the  presence  of  material  that  is  foul  and  nox- 
ious to  grov\^ing  animals.  There  is  nothing  dirty 
or  filthy  when  it  is  in  the  right  place.  Cow  dung, 
urine,  and  effete  matter  from  the  lungs  and  skin 
will  make  healthy  fodder  for  the  animals  that 
eliminate  it  when  the  material  is  put  in  the  right 
place  under  proper  conditions.  But  cow  dung 
plastered  over  the  sides  of  the  cow,  or  allowed  to 
accumulate  in  the  living  place  with  the  animal 
that  drops  it,  standing  constantly  in  the  dung  and 
urine  she  herself  makes,  besides  fouling  the  air, 
gives  rise  to  foot-foul  and  other  painful  afflictions 
that  are  markedly  debilitating;  breathing  over 


136       What  Must  We  Do  to  be  Saved? 

and  over  again  the  same  air  must  lead  to  pulmxon- 
ary  susceptibility  to  disease;  feeding  on  the  refuse 
matter  from  distilleries,  breweries,  glucose  and 
starch  factories  must  tend  to  nutritive  ailments, 
and  all  these  common  conditions  of  our  dairies 
generate  a  marked  susceptibility  to  profound 
constitutional  diseases  of  which  tuberculosis  is 
the  chief.  Many  people  who  are  not  familiar 
with  the  condition  of  a  large  number  of  our  dairy 
stables  may  imagine  that  there  is  some  exaggera- 
tion in  the  foregoing  statements,  but  I  have  never 
seen  any  one  who,  without  previous  knowledge 
of  the  existing  conditions,  after  having  made  an 
inspection  of  a  number  of  dairies  furnishing  milk 
for  food,  has  not  returned  v\^ithout  a  profound 
disgust  at  the  state  of  affairs.  It  is  not  uncom- 
mon to  find  fifteen  or  twenty  cows  confined  in  a 
damp  basement  where  no  effort  is  made  to  ob- 
serve cleanliness,  and  every  effort  possible  is 
made  to  exclude  external  air  during  the  cold 
weather,  and  thus  the  cows  are  kept  warm  by 
their  own  reeking  breath,  made  doubly  noxious 
by  the  accumulating  filth  and  the  stench  from  the 
refuse  food. 

The  milk  from  these  animals  is  received  in  ves- 
sels seldom  or  never  properly  cleaned,  and  taken 
to  be  bottled  or  canned  into  the  dwelling-house, 
where  poverty  and  a  natural  tendency  to  shiftless- 


What  Must  We  Do  to  be  Saved?       137 

ness  make  everything  as  dirty  as  it  is  possible  to 
be.  I  will  guarantee  to  direct  anybody  to  dairies 
where  the  foregoing  conditions  prevail  and  the 
milk  is  sold  for  infant  feeding.  Will  any  reason- 
able man  af^rm  that  the  State  is  doing  its  whole 
duty  w4ien  it  sends  an  inspector  to  such  a  stable 
to  kill  a  few  of  the  cows  and  do  nothing  more? 
The  following  is  the  State  law  that  applies  to  just 
these  cases,  and  is  copied  from  the  Revised  Stat- 
utes, vol.  i,  under  the  head  of  Dairy  Products, 
sec.  12: 

"  The  Proper  Care  of  Cozvs,  and  using  Diseased 
Milk  in  Making  Articles  of  Food. — No  person  shall 
keep  cows  for  the  productions  of  milk  for  market, 
or  for  sale  or  exchange,  or  for  manufacturing  the 
same  or  cream  from  the  same  into  articles  of  food, 
in  a  crowded  or  unhealthy  condition,  or  feed  the 
cows  on  food  that  is  unhealthy,  or  that  produces 
impure,  unhealthy,  diseased,  or  unwholesome 
milk.  No  person  shall  manufacture  from  impure, 
unhealthy,  diseased,  or  unwholesome  milk,  or  of 
cream  from  the  same,  any  article  of  food.  Who- 
ever violates  the  provisions  of  this  section  is 
guilty  of  a  misdemeanor,  and  shall  be  punished 
by  a  fine  of  not  less  than  twenty-five  dollars  nor 
more  than  two  hundred  dollars,  or  by  imprison- 
ment of  not  less  than  one  month  nor  more  than 
four  months,  or  by  both  such  fine  and  imprison- 


138       What  Must  We  Do  to  be  Saved? 

ment  for  the  first  offense,  and  by  four  months' 
imprisonment  for  each  subsequent  offense. 

Would  it  be  unreasonable  to  assert  that  the 
enforcement  of  this  section  of  the  statute  would 
do  more  for  the  stamping  out  of  tuberculosis 
than  all  the  efforts  that  have  heretofore  been 
made  by  State  authorities?  I  have  kept  pretty 
close  watch  of  the  work  being  done  in  this  State 
by  the  authorities  whose  duty  it  is  to  enforce  the 
laws  relating  to  dairies,  and  I  have  yet  to  see 
where  any  one  has  ever  been  apprehended  for  a 
violation  of  the  above  section,  and  I  know  that 
this  section  of  the  law  is  frequently  and  largely 
violated.  The  greatest  number  of  prosecutions 
has  been  against  the  oleomargarine  dealers. 

This  may  be  proper  commercially,  but  from 
our  point  of  view,  as  medical  men,  it  would  be  of 
greater  benefit  to  the  health  of  the  State  to  let 
the  imitation  butter  alone  and  improve  the  health 
of  our  cattle  and  the  purity  of  the  product  de- 
rived therefrom. 

I  have  often  been  asked  why  I  do  not  bring 
proceedings  against  violaters  of  the  law  if  I  know 
of  such  cases;  but,  as  I  myself  keep  cows  and  sell 
milk,  my  motives,  if  I  took  such  action,  would  be 
liable  to  misconstruction.  Now,  to  sum  up,  what 
I  would  recommend,  if  my  opinion  were  asked, 
would  be,  first  and  foremost,  to  educate  inspec- 


What  Must  We  Do  to  be  Saved?       139 

tors  to  a  thorough  knowledge  of  the  conditions 
necessary  to  breed  and  feed  and  care  for  dairy 
stock  in  such  a  manner  that  there  would  be  the 
least  possible  disease  and  danger;  and  then  an 
unbiased  enforcement  of  the  law  as  it  exists  to- 
day, turning  the  commercial  supervision  into  an- 
other channel.  In  fact,  the  bureau  of  agriculture 
of  the  State  of  New  York  takes  good  care  to-day 
of  the  commercial  interests  involved  in  the  dairy 
business. 

For  the  immediate  improvement  of  our  milk 
supply,  I  would  recommend  the  formation,  in 
every  community,  of  a  society  of  dairy  supervis- 
ion; this  society  to  be  composed  of  doctors  and 
veterinarians,  who  will  make  rules  to  govern 
dairies  in  their  vicinity,  and  who  will  certify  as  to 
the  quality  of  milk  supplied  to  the  community  by 
dairy  men  who  are  willing  to  obey  and  positively 
carry  out  the  rules  of  the  association.  This  to  be 
called  "  approved  milk."  Probably  one  of  the 
greatest  obstacles  to  the  proper  conduct  of  a 
dairy  is  the  low  price  of  milk,  and  if  this  associa- 
tion of  dairy  supervision  was  properly  conducted 
the  ''  approved  miilk  "  would  command  a  better 
price.  When  milk  is  produced,  as  it  ought  to  be, 
for  the  health  of  the  community,  it  must  bring  a 
larger  price  than  it  commands  now. 

When  it  is  not  possible  or  advisable  to  form 


140       What  Must  We  Do  to  be  Saved? 

dairy  supervisory  associations,  if  our  local  boards 
of  health,  instead  of  making  health  codes  that  are 
never  enforced,  would  inspect  the  dairies  in  their 
vicinity  and,  where  they  found  any  that  were 
filthy  and  contained  diseased  cows,  report  this  to 
the  dairy  inspector  of  their  district,  and,  if  the  in- 
spector would  not  perform  his  duty  properly, 
proceed  against  him.  In  this  manner  the  laws  as 
they  exist  now  could  be  enforced,  and  thus  the 
dairy  cow  would  become  what  she  should  be — a 
useful  and  not  a  dangerous  animal. 


COMMENTS. 

Regarding  the  last  paper  in  this  latter  book,  it 
may  not  be  amiss  to  print  a  few  comments. 
Nearly  every  paper  in  the  series  has  received 
some  sort  of  criticism  or  commendation,  but 
these  recent  communications  will  indicate 
slightly  just  how  the  subject  is  attracting  atten- 
tion. 

Philadelphia,  Pa.,  Feb.  7,  1898. 

E.  F.  Brush,  M.  D., 

Mount  Vernon,  N.  Y. 
Dear  Doctor. — Your  article, ''  What  Must  We 
Do  to  be  Saved  from  Tuberculosis?  "  a  reprint  of 
which  you  kindly  sent  me,  is  truly  science  up  to 
date.     I  congratulate  you  on  your  good  work. 
With  best  wishes, 

Sincerely  yours, 

J.  J.  TAYLOR. 


Washington,  D.  C,  January  4,  1898. 
Dr.  E.  F.  Brush, 

Mount  Vernon,  N.  Y. 
Dear  Sir. — Please  accept  my  thanks  for  a  copy 
of  your  little  pamphlet  entitled  ''  What  Must  We 
Do  to  be  Saved  from  Tuberculosis,"  reprinted 
from  the  New  York  Medical  Journal  of  August 
14,  1897.  I  have  been  much  interested  in  the 
paper,  and  if  you  can  spare  them,  I  will  thank 
your  for  two  or  three  additional  .copies  for  the 


142  Comments. 

use  of  this  office.  The  printed  franks  which  I 
enclose  will  bring  the  pamphlets  by  mail  free  of 
postage. 

Very  truly  yours, 

HENRY   E.  ALVORD, 
Chief  of  Dairy  Division. 


Port  Jervis,  N.  Y.,  Jan.  5,  1898. 
E.  F.  Brush,  M.  D., 

Mount  Vernon,  N.  Y. 

Dear  Sir. — I  am  in  receipt  of  your  address  and 
am  delighted  with  it.  It  is  the  first  gleam  of 
common  sense  that  I  have  seen  on  the  subject 
coming  from  your  profession,  and  I  thoroughly 
appreciate  it.  1  should  like  to  pubHsh  it  in  our 
columns,  and  if  you  do  not  object,  I  will  do  so. 
For  that  purpose  I  would  need  another  copy, 
if  you  can  spare  one. 

I  congratulate  you  on  the  paper;  it  is  full  of 
wisdom  and  it  should  go  in  the  hands  of  the 
State  Board  of  Health  and  especially  of  the 
Tuberculosis  Commiission — that  committee  who 
have  done  nothing  but  bleed  the  taxpayers  and 
breed  a  senseless  scare.  I  am  sincerely  obliged  to 
you  for  the  paper  and  remain, 

Yours  respectfully, 

E.  G.  FOWLER. 


Haughville,  Ind.,  Feb.  15,  1898. 
Mr.  E.  F.  Brush,  M.  D., 

Dear  Sir. — I  was  reading  a  short  piece  in  the 
Dairy  World,  headed,  "  What  Must  We  Do  to 


Comments.  143 

be  Saved  from  Tuberculosis?"  as  a  title  of  a 
pamphlet,  and  as  I  am  a  dairyman,  I  would  like 
very  much  to  read  the  little  book.  Inclosed 
please  find  stamp  for  reply. 

Yours  truly, 

A.  E.  FRAZEE. 


[From  the  Albany,  N.  Y.,  Express,  Dec.  28,  1897.] 

THE  TUBERCULOSIS  QUESTION. 

''What  Must  We  Do  to  be  Saved  From 
Tuberculosis?"  is  the  title  of  a  paper  read  by  Dr. 
E.  F.  Brush,  of  Mount  Vernon,  before  the  Medi- 
cal society  of  the  county  of  Westchester,  which 
was  published  in  the  New  York  "  Medical  Jour- 
nal "  and  has  now  been  issued  in  pamphlet  form 
for  general  distribution. 

Dr.  Brush  agrees  with  the  State  Board  of 
Health  in  its  belief  that  the  prevalence  of  tuber- 
culosis in  human  beings  in  due  largely  to  infec- 
tion from  milk  and  the  meat  of  cows;  but  he  as- 
serts that  the  Board  is  not  proceeding  in  the 
right  manner  to  eradicate  tuberculosis  among 
cattle.  He  reasons  justly  that  the  kilHng  of  cat- 
tle that  are  found  to  be  infected  can  do  compara- 
tively httle  toward  the  accomplishment  of  the 
main  purpose  while  the  conditions  that  breed 
tuberculosis  are  allowed  to  remain.  In  short, 
he  points  out  that  the  State  Board  of  Health 
does  not  strike  at  the  root  of  the  evil  because  it 
does  not  adopt  measures  to  prevent  the  develop- 
ment of  the  disease. 


144  Comments. 

Dr.  Brush  directs  attention  to  the  neglect 
which  bovine  pathology  has  suffered.  The  vet- 
erinary colleges  have  kept  the  study  of  equine, 
canine  and  even  feline  pathology  up  to  the  times, 
but  the  term  "  cow-doctor "  is  used  among 
veterinarians  as  "  quack  "  is  used  among  healers 
of  the  human  species.  Intelligent  cow^-doctors 
are  needed;  men  who  have  a  proper  knowledge 
of  the  hygienic  conditions  necessary  to  insure 
the  health  of  cattle,  who  can  prevent  and  elimi- 
nate tuberculosis  from  the  dairies  without  whole- 
sale slaughter. 


New  York,  Feb.  28,  1898. 

When  you  can  find  nothing  only  the  Bible  to 
use  to  advertise  your  milk,  you  are  a  sorry  man, 
and  I  will  neither  countenance  your  advertising 
nor  your  milk  in  any  way. 

A.  N.  Y.  M.  D. 


February  28,  1898. 
My  Dear  Dr.  Brush, 

I  have  just  read  your  reprint,  "  What  Must 
W^e  Do  to  be  Saved  From  Tuberculosis?"  I 
also  read  your  article  in  the  New  York  Medical 
Journal.  I  feel  that  you  should  be  encouraged 
in  your  work. 

Yours  sincerely, 

W.  H.  BATES. 


DUE  DATE 


COLUMBIA  UN'SaKlSfflr 


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